Seeing High Blood Pressure and Worse

While reading a recent Science-Based Medicine post, there was an interesting exchange among a bunch of the commenters, many of whom are medical professionals.

It started with someone named EBMOD:

…as eye doctors we see hypertensive retinopathy a fair amount… [caused by uncontrolled high blood pressure]

Then someone named Avatar replied:

Since I have hypertension along with my diabetes, not as well-controlled as I would like on poorly tolerated meds, I ask my ophthalmologist about hypertensive retinopathy. He states he rarely sees it anymore since drug regimens have lowered pressures, especially the extremely high ones. Of course, he sees people in a population that actually try to comply with medical recommendations and are at least aware that they have hypertension. Pity the poor guy who never has to see a doctor and has sported a pressure of 280/110 for 10 or 20 years.

To which EBMOD replied with this fact I never thought about:

And this ties in well with why I love medical eye exams. I consider us a 'canary in the coal mine' for so many things. The inside of the eye is the only place in the body where you can view blood vessels directly without cutting a person open and as such, many cardiovascular issues can be seen. Hypertension, congestive heart failure, kidney failure, signs of MS, diabetes, and high cholesterol can all be caught by examination of the retina.

How we typically see hypertensive retinopathy is, as an example, a 32-year-old who hasn't had a physical in 10 years, but has noticed his vision has gone blurry, so he comes in and we see that the retina has blown up due to hypertensive damage. So we check blood pressure, see that they're in malignant hypertension and call an ambulance...

Then this from LovleAnjel:

Yup, my husband only found out about his hypertension through his optometrist. They immediately stopped the exam and made him see our doctor (for the first time, of course) before they would renew his contacts.

They said they have called an ambulance for someone on more than one occasion.

EBMOD then reminded everyone of the need for dilated retinal exams:

….All optometrists have seen dilated retinal exams save lives and as such, I think it a horrible precedent the way that their importance is being actively eroded. Personally, I've averaged probably one person a year who had a potentially lethal (and I mean acute/in the short term) condition caught for the first time via retinal exam.

The general public has no idea how a retinal exam screens for so many diseases outside of the eyes themselves. It always blows me away how people will do anything and everything to get out of a dilation.

Definitely an area where the public's risk/reward perception is completely out of whack...

So that's why they put those drops in our eyes that make us need sunglasses for a few hours. I knew there had to be a reason for them, but I don't remember ever hearing any of this.

As EBMOD said, if people realized the problems that can be headed off with dilation, they would be more willing to put up with the discomfort.