Blood Pressure Assessment in Ophthalmology Clinics for Patients With Diabetes

Importance: Hypertension is a major modifiable risk factor for diabetic retinopathy progression but may not be assessed routinely during ophthalmology visits. Objective: To evaluate prevalence of elevated or uncontrolled blood pressure (BP) among adults with diabetes presenting for ophthalmologic care and patient attitudes toward in-clinic screening. Design, Setting, and Participants: This prospective case series was conducted from July 2024 to August 2024 at a single academic retina clinic. Data were analyzed from October 2025 to December 2025. Adults aged 18 years or older with type 1 or type 2 diabetes underwent in-clinic BP measurement and completed a structured survey on hypertension history, monitoring, perceived control, and knowledge. Additional clinical and ophthalmic data were obtained from electronic medical records. Main Outcomes and Measures: The primary outcome was the prevalence of elevated BP and hypertension stage by 2017 American College of Cardiology/American Heart Association criteria, in which classification depends on both systolic and diastolic values. Normal BP was defined as systolic BP less than 120 mm Hg and diastolic BP less than 80 mm Hg; elevated, systolic BP 120 to 129 mm Hg and diastolic BP less than 80 mm Hg; stage 1 hypertension, systolic BP 130 to 139 mm Hg or diastolic BP 80 to 89 mm Hg; stage 2 hypertension, systolic BP of 140 mm Hg or higher or diastolic BP of 90 mm Hg or higher; and hypertensive crisis, systolic BP higher than 180 mm Hg and/or diastolic BP higher than 120 mm Hg. Results: Among 172 patients (mean [SD] age, 66.6 [13.9] years; 84 female patients [48.8%]), 14 (8.1%) had normal blood pressure, 91 (52.9%) had stage 2 hypertension, and 18 (10.5%) met criteria for hypertensive crisis. A prior diagnosis of hypertension was present in 144 of 172 patients (83.7%); among these, 131 of 144 patients (91.0%) were receiving antihypertensive therapy. Among 28 patients without known hypertension, 24 of 28 (85.7%) had above-normal blood pressure, including 10 of 28 (35.7%) with stage 2 hypertension and 3 of 28 (10.7%) in hypertensive crisis. Although 100 of 144 patients with diagnosed hypertension (69.4%) perceived their control as good or excellent, 115 (79.9%) had BP stage 1 or greater. Following measurement, 103 of 172 patients (59.9%) were advised to contact their primary care clinician, and 20 of 172 (11.6%) required expedited follow-up. Conclusions and Relevance: In this single-center case series, uncontrolled or previously unrecognized hypertension was highly prevalent among patients with diabetes, even among those engaged in routine medical follow-up. Opportunistic BP screening in ophthalmology clinics appears feasible and may identify actionable cardiovascular risk.