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WanFen Yip, Peter Moey, Ngiap Chuan Tan, Sally Low, Xing Xiu Ho, Lieng Hsi Ling, Tien Wong, Carol Cheung; Retinal Vascular Caliber and Hypertension Diagnosis in the Primary Care Setting. Invest. Ophthalmol. Vis. Sci. 2013;54(15):22.
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© ARVO (1962-2015); The Authors (2016-present)
Isolated blood pressure (BP) measurement in the clinic setting may misclassify people as having hypertension and identifying persons with true sustained hypertension (confirmed hypertension) is important to avoid over treatment. Retinal arteriolar narrowing is strongly related to not only past and present BP levels but is also predictive of future hypertension. We examined the association of retinal vascular caliber with hypertension status in a primary care setting.
We conducted a clinic-based study in a primary care setting in Singapore. We recruited non-diabetic subjects with suspected hypertension (defined as 2 consecutive readings of clinic BP >140/90mmHg taken by the same doctor on the same day using a mercury sphygmomanometer). These subjects had 24-hour ambulatory BP, home-monitoring BP, and retinal fundus photography. Retinal vascular caliber was measured from the digital photographs using a computer-assisted program (Singapore I Vessel Assessment [SIVA], software version 3.0) following a standardized protocol. Confirmed hypertension was defined as 24-hour ambulatory BP ≥ 135/85mmHg. Mean arterial BP (MABP) was calculated as two-thirds of the diastolic plus one-third of the systolic BP. Multivariable logistic regression analyses were performed to examine the associations between retinal vascular calibre and hypertensive status (confirmed hypertension vs. no confirmed hypertension).
A total of 44 participants with suspected hypertension were included. The prevalence of confirmed hypertension was 40.9% (18/44). The mean (SD) CRAE for those with confirmed hypertension was 130.92 (10.07) µm and those without confirmed hypertension was 139.46 (7.33) µm (p = 0.002). Retinal arteriolar caliber was more strongly correlated with ambulatory MABP (Pearson correlation coefficient r = -0.46, p=0.002) and home MABP (r = -0.40, p=0.009), than clinic MABP (r = -0.16, p=0.29). In the logistic regression model, controlling for age, gender and clinic MABP, each 10µm decrease in CRAE was independently associated with confirmed hypertension. (OR 2.96, 95%CI: 1.10 to 7.94).
Retinal arteriolar narrowing was associated with confirmed hypertension measured from 24-hour ambulatory BP. Our findings suggest that retinal photography may potentially aid physicians in stratifying patients with true sustained hypertension in the primary care setting.
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