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T.Y. Wong, R. Klein, A.R. Sharrett, D.J. Couper, B.E. Klein, L.D. Hubbard; Retinal Arteriolar Narrowing and Risk of Hypertension: The Atherosclerosis Risk in Communities Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2052.
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Purpose: To determine the association of retinal arteriolar narrowing and risk of hypertension. Methods: Retinal photographs were taken in a population-based cohort of 5,628 persons aged 49 to 73 years without a history of hypertension. To quantify retinal arteriolar narrowing, the photographs were digitized, diameters of individual arterioles and venules were measured on the computer, and a summary arteriole-to-venule ratio (AVR) was computed, with lower AVR indicating greater retinal arteriolar narrowing. Areas of focal arteriolar narrowing were also defined using a standard grading protocol. Incident cases of hypertension was identified from this cohort and defined as systolic blood pressure 140 mmHg or higher, diastolic blood pressure 90 mmHg or higher, or use of anti-hypertensive medication. Results: After 3 years of follow-up, 811 (14.4%) persons developed hypertension. The incidence of hypertension was higher in persons with generalized retinal arteriolar narrowing (incidence of 8.9%, 12.3%, 13.7%, 14.3%, 22.3%, comparing decreasing quintiles of AVR) and in persons with focal retinal arteriolar narrowing (25.1% versus 13.0%, comparing presence and absence of focal narrowing). After controlling for age, gender, race, the average systolic and diastolic blood pressures over a 6 year period, body mass index, waist-hip ratio, diabetes and other risk factors, the risk of hypertension was 60% higher in persons with generalized (relative risk 1.62, 95% confidence interval, 1.21, 2.18, comparing lowest to highest AVR quintile) and focal (relative risk 1.61, 95% confidence interval, 1.27, 2.04, p<0.001) retinal arteriolar narrowing. Conclusions: People with narrowed retinal arterioles have a higher risk of hypertension, independent of other factors. These data further support the clinical value of a quantitative assessment of retinal arteriolar change from photographs for cardiovascular risk prediction.
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