Effectiveness of in-office blood pressure measurement by eye care practitioners in early detection and management of hypertension clinic

AIM: Many of the eye care practitioners (ECPs) in Saudi Arabia practice in optical stores. These stores are wide spread, easily assessable and seldom need appointments. The expanding role of the ECP as a primary health care provider (PHCP) and the increasing global prevalence of hypertension, highlight the need for an integrated approach towards management of hypertension. This pilot study sort to investigate the number of hypertensive patients the ECP is able to identify by routinely taking blood pressure (BP) measurements and the patients’ opinion regarding in-office BP measurement. METHODS: Automated BP measurements were twice obtained in five selected optometry practices using a validated BP monitor (Omron M6) to access the number of patients with high BP (HBP) visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and obtaining accurate BP readings. A protocol for BP measurement was distributed and kept in all participating clinics. The general attitude towards cardiovascular health of 480 patients aged 37.2 (12.4) years and their opinion towards in-office BP measurement was assessed using a self-administered questionnaire. RESULTS: There is an increased awareness of hypertension in Saudi Arabia, but with a general poor attitude by patients towards their cardiovascular health. A response rate of 83.6% was obtained from the survey and participants were very positive (54%) in their opinion regarding the monitoring of BP in eye clinics. Many of the patients (69.8%) appreciated the routine measurement of BP in optometry practices. They stated that it was not time consuming (31.5%) and will save time they would have spent visiting a hospital for such routine checks (64%). Patients (38.5%) also do not think their BP status is related to their ability to see well. Ninety-three of the 443 patients (21.0%) tested for BP in this study had HBP. Of these 93 subjects, 67.7% were unaware of their HBP status. Thirty of the 105 subjects (28.6%) who had previously been diagnosed had HBP at the time of this study and only 22 (73.3%) were on medication. Also, only 25% of the previously aware hypertensive patients owned a BP monitor. CONCLUSION: Taking BP measurement in optometry practice is able to identify one hypertensive patient for every 8 adults tested with HBP who were unaware and patients appreciate the routine measurement of BP by the Optometrists. These findings re-iterate the potential role of eye care practitioners towards early detection/monitoring of the hypertensive patient. were required to attend a two-day active training workshop by a Cardiologist (HM) on hypertension and the use, operation, and calibration of the automated oscillatory BP monitor, the Omron M6 Comfort (OMRON Healthcare Co., Ltd., Kyoto, Japan), used in this study. During the training sessions, to ensure accuracy of BP readings, the optometrists had to measure arm sizes of practice subjects to get a gauge of patient's arm sizes in relation to body size. The clinicians were asked to measure the arm size of a patient, during the data collection, if they taught it might exceed 42cm or be less than 22cm. The Omron M6 uses a long comfort cuff size designed to fit arm circumference (22 - 42 cm) of most subjects. The Omron M6 was selected for use in this study because it’s one of the automated validated devices [43] and for its comfort cuff. Seven Omron M6 BP monitors was distributed to the participating optometrists for the purpose of data collection.