Prevalence of hypertensive retinopathy and its risk for mortality – results from the Gutenberg Health Study

Abstract

Purpose : The evaluation of the retinal vasculature can be used to detect end organ damage and to stratify cardiovascular risk in patients with arterial hypertension. In this study we investigate the relationship between hypertensive retinopathy and mortality in a population-based cohort.

Methods : The Gutenberg Health Study is a population-based study with 15,010 participants aged 35 to 74. An ophthalmological examination was performed including fundus photography. Grading of hypertensive retinopathy signs (focal and generalized arterial narrowing, arteriovenous notching, retinal bleedings, microaneurysms, cotton wool spots, hard exudates, macular edema, papilledema) was conducted at Mainz Ophthalmic Reading Center and classified according to Mitchell-Wong-Classification. Data from the residents' registration offices were used to determine whether and when a study participant had passed away. Age- and sex-weighted prevalence estimators for hypertensive retinopathy in the German population (2014) including 95% confidence intervals (CI) were computed. Using Cox regression analysis, the relationship between hypertensive retinopathy and mortality was analyzed taking classic cardiovascular risk factors (age, sex, smoking, dyslipidemia, arterial hypertension, diabetes, body-mass-index, family history of stroke and myocardial infarction) into account.

Results : 12,751 persons (49.8% female) with an average age of 55.9±11.1 years were included in this analysis. 6.7% (95% CI: 6.3% - 7.2%) had mild and 4.0% (95% CI: 3.7% - 4.4%) moderate hypertensive retinopathy. The median follow-up time was 8.6 years. There was an association between hypertensive retinopathy and mortality, both after adjustment for age and sex (mild: HR=1.24, p=0.06; moderate: HR=1.99, p<0.001; reference: no) and after adjustment for classic cardiovascular risk factors (mild: HR=1.23, p=0.08; moderate: HR=1.75, p<0.001; reference: no).

Conclusions : The prevalence of hypertensive retinopathy is 6.7% for the mild form and 4.0% for the moderate form in the German population at age 35 to 74 years. In particular, the moderate form of hypertensive retinopathy is a risk factor for mortality independent of classic cardiovascular risk factors. Patients with such changes should have a thoughtful general examination and their cardiovascular risk factors should be optimized.

This is a 2020 ARVO Annual Meeting abstract.