JAMA 22/29 Aug 2007 Vol 298

A question for all GP readers – where do you keep your paediatric sphygmomanometer cuff? Do you know if your practice actually has one? I haven’t checked our premises yet, so you can tell how often I measure blood pressure in children. Adolescents occasionally get it done, usually because they have known renal failure or want oral contraception. Most hypertension in children and adolescents goes undetected, as this cohort study from Ohio confirms: but do we know if it makes any difference whether we detect elevated blood pressure at 10 or at 18?

A useful review of the management of diabetic retinopathy, which fortunately for laser-challenged readers includes a good section on prevention as part of management.  Control glycaemia down to an HbA1c of 7.5ish: although theoretically you could try for lower, returns diminish and complications increase. Control blood pressure down to…nobody knows, probably till the patient falls over. Then it’s over to the laser boys, who don’t know quite how early to intervene; but once the retinopathy is severe, pan-retinal treatment (sparing the macula) is definitely the thing. If the jelly of the eye gets bled into repeatedly, it’s best to remove it (vitrectomy). Marvellous what chaps like Lord Darzi can do. If only they would confine themselves to what they know about.