Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

Yu-Ting LI; Yi WANG; Xiu-Jing Hu; Jia-Heng CHEN; Yun-Yi LI; Qi-Ya ZHONG; Hui CHENG; Bedru H. MOHAMMED; Xiao-Ling LIANG; Jose HERNANDEZ; Wen-Yong HUANG; Harry H.X. WANG

doi:10.3390/healthcare9050580

Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

Yu-Ting LI, Yi WANG, Xiu-Jing Hu, Jia-Heng CHEN, Yun-Yi LI, Qi-Ya ZHONG, Hui CHENG, Bedru H. MOHAMMED, Xiao-Ling LIANG, Jose HERNANDEZ, Wen-Yong HUANG^*, Harry H.X. WANG^*

^*Corresponding author for this work

Research output: Journal Publications › Journal Article (refereed) › peer-review

9 Citations (Scopus)

Abstract

A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words).

Original language	English
Article number	580
Number of pages	13
Journal	Healthcare (Switzerland)
Volume	9
Issue number	5
DOIs	https://doi.org/10.3390/healthcare9050580
Publication status	Published - 13 May 2021
Externally published	Yes

Bibliographical note

Acknowledgments:
We wish to acknowledge the community liaison support from the local Health Commission (Bureau) in establishing the Specialist–Generalist Working Alliance. We also thank our research collaborators and frontline clinical staff at primary care facilities who were involved in the family doctor team care provision and patient referral. We also acknowledge Isabella Tan from Macquarie University for her valuable inputs in the interpretation of study results.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Funding

This work was supported by the National Natural Science Foundation of China [Grant Numbers 71673309, 71904212]; Open Research Funds of the State Key Laboratory of Ophthalmology [Grant Number 303060202400362]; Science and Technology Development Fund of Guangdong Province [Grant Number 2016A020216006]; Special Support Program of Guangdong Province [Grant Number 2017TQ04R749]; Basic and Applied Basic Research Foundation of Guangdong Province [Grant Number 2019A1515011381]; and Higher Education Reform Project of Guangdong Province [Grant Number 20191206-20]. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Keywords

Association
Diabetic retinopathy
Healthcare
Risk factor
Systolic blood pressure
Type 2 diabetes management

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3390/healthcare9050580Licence: CC BY

Cite this

LI, Y.-T., WANG, Y., Hu, X.-J., CHEN, J.-H., LI, Y.-Y., ZHONG, Q.-Y., CHENG, H., MOHAMMED, B. H., LIANG, X.-L., HERNANDEZ, J., HUANG, W.-Y., & WANG, H. H. X. (2021). Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications. Healthcare (Switzerland), 9(5), Article 580. https://doi.org/10.3390/healthcare9050580

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title = "Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications",

abstract = "A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to {\textquoteleft}clinical inertia{\textquoteright} in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words).",

keywords = "Association, Diabetic retinopathy, Healthcare, Risk factor, Systolic blood pressure, Type 2 diabetes management",

author = "Yu-Ting LI and Yi WANG and Xiu-Jing Hu and Jia-Heng CHEN and Yun-Yi LI and Qi-Ya ZHONG and Hui CHENG and MOHAMMED, {Bedru H.} and Xiao-Ling LIANG and Jose HERNANDEZ and Wen-Yong HUANG and WANG, {Harry H.X.}",

note = "Acknowledgments: We wish to acknowledge the community liaison support from the local Health Commission (Bureau) in establishing the Specialist–Generalist Working Alliance. We also thank our research collaborators and frontline clinical staff at primary care facilities who were involved in the family doctor team care provision and patient referral. We also acknowledge Isabella Tan from Macquarie University for her valuable inputs in the interpretation of study results. Publisher Copyright: {\textcopyright} 2021 by the authors. Licensee MDPI, Basel, Switzerland.",

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month = may,

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doi = "10.3390/healthcare9050580",

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LI, Y-T, WANG, Y, Hu, X-J, CHEN, J-H, LI, Y-Y, ZHONG, Q-Y, CHENG, H, MOHAMMED, BH, LIANG, X-L, HERNANDEZ, J, HUANG, W-Y & WANG, HHX 2021, 'Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications', Healthcare (Switzerland), vol. 9, no. 5, 580. https://doi.org/10.3390/healthcare9050580

Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications. / LI, Yu-Ting; WANG, Yi; Hu, Xiu-Jing et al.
In: Healthcare (Switzerland), Vol. 9, No. 5, 580, 13.05.2021.

Research output: Journal Publications › Journal Article (refereed) › peer-review

TY - JOUR

T1 - Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

AU - LI, Yu-Ting

AU - WANG, Yi

AU - Hu, Xiu-Jing

AU - CHEN, Jia-Heng

AU - LI, Yun-Yi

AU - ZHONG, Qi-Ya

AU - CHENG, Hui

AU - MOHAMMED, Bedru H.

AU - LIANG, Xiao-Ling

AU - HERNANDEZ, Jose

AU - HUANG, Wen-Yong

AU - WANG, Harry H.X.

N1 - Acknowledgments: We wish to acknowledge the community liaison support from the local Health Commission (Bureau) in establishing the Specialist–Generalist Working Alliance. We also thank our research collaborators and frontline clinical staff at primary care facilities who were involved in the family doctor team care provision and patient referral. We also acknowledge Isabella Tan from Macquarie University for her valuable inputs in the interpretation of study results. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

PY - 2021/5/13

Y1 - 2021/5/13

N2 - A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words).

AB - A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words).

KW - Association

KW - Diabetic retinopathy

KW - Healthcare

KW - Risk factor

KW - Systolic blood pressure

KW - Type 2 diabetes management

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U2 - 10.3390/healthcare9050580

DO - 10.3390/healthcare9050580

M3 - Journal Article (refereed)

AN - SCOPUS:85106756387

SN - 2227-9032

VL - 9

JO - Healthcare (Switzerland)

JF - Healthcare (Switzerland)

IS - 5

M1 - 580

ER -

Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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