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H. Leung, J.J. Wang, P. Mitchell, E. Rochtchina, T.Y. Wong, R. Klein, Blue Mountains Eye Study; Hypertension and Retinal Vascular Changes in an Older Population: The Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2051.
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Purpose: To describe the cross-sectional relationship between hypertension and retinal vascular changes in an older population. Methods: Retinal photographs from right eyes of participants (n= 3654, aged 49+ years) were digitized. All retinal vessels within 0.5-1.0 disc diameter from the optic disc margin were measured using a computer-assisted program. Summarized estimates of central retinal arteriolar equivalent (CRAE), representing the average arteriolar diameter, and arteriole-to-venule ratio (AVR), were calculated. Focal arteriolar narrowing, arteriovenous (A/V) nicking, and retinopathy lesions (microaneurysms, haemorrhages, hard/ soft exudates) were graded from 35 mm transparencies using a light box. Hypertension was defined in subjects using anti-hypertensive medication(s) or with systolic BP≥160mmHg or diastolic BP≥95mmHg at the examination. These cases were divided into 3 groups: controlled (using medication, normal BP), uncontrolled (using medication, high BP) and untreated (not using medication). Lowest quintiles of CRAE or AVR represented generalized arteriolar narrowing. Results: Of the 3355 participants with gradable photos, 1837 (54.9%) were normotensive, 609 (18.2%) had controlled, 441 (13.2%) uncontrolled and 459 (13.7%) untreated hypertension. The age-adjusted mean CRAE was 196,193,189 and 187µm and the adjusted mean AVR was 0.87, 0.86, 0.85 and 0.84, respectively, for the corresponding 4 groups. After adjusting for age, sex, body-mass index and smoking, persons with controlled, uncontrolled or untreated hypertension were significantly more likely than normotensive subjects to have: (1) smaller CRAE: adjusted odds ratios OR 1.5, (95% confidence intervals 1.2-1.9), 2.5 (1.9-3.2) and 2.0 (1.6-2.6), respectively; (2) lower AVR: adjusted OR 1.2 (0.9-1.5), 1.7 (1.3-2.1) and 1.7 (1.2-2.1), respectively; (3) focal arteriolar narrowing: 1.4 (0.9-2.1), 2.0 (1.3-2.9) and 2.5 (1.7-3.6), respectively); (4) AV nicking: 1.3 (0.9-1.8), 2.0 (1.4-3.0) and 1.9 (1.3-2.7) respectively; and (5) retinopathy lesions (in non-diabetic subjects): 1.4 (1.0-2.0), 2.0 (1.5-2.8) and 1.6 (1.1-2.2), respectively. Conclusions: Our findings from a general older population show a strong relationship of hypertension to retinal microvascular changes.
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