Five-year Incidence of Arterial Hypertension Predicted by Retinal Vessel Analysis: The Tongren Cohort Study

Abstract

Purpose : To study the relationship between retinal vessel caliber and tortuosity and the 5-year incidence of hypertension.

Methods : The community-based longitudinal Tongren Cohort Study included individuals undergoing routine health examinations. Using a proved deep learning model called vessel-constraint network, the retinal vessel calibers and tortuosity within a region of 0.5 to1.5 disc diameters from the disc margin were automatically segmented, based on color fundus images.

Results : A total of 9230 individuals(age: 43.6±13.9years) were enrolled, with the 5-year cumulative incidence of hypertension to be 18.8% and severe hypertension to be 7.0%. Narrower retinal arteriolar (odds ratio(OR):0.98; 95%CI:0.97,0.99; P<0.001), wider venular (OR:1.006; 95%CI:1.002,1.01;P=0.005), and smaller arteriole-to-venule caliber ratio (OR:0.72;95%CI:0.63,0.82;P<0.001) were associated with increased hypertension incidence after multivariable adjustment. Compared with individuals with the 5% widest arteriolar or the 5% narrowest venular, those with the 5% narrowest arteriolar or the 5% widest venular had a 17.1-fold or 2.3-fold increased risk for developing hypertension within 5 years. The receiver operating curves(ROC) for retinal vessel calibers to predict hypertension and severe hypertension was 0.79 (95%CI:0.78,0.80) and 0.84 (95%CI:0.82,0.86), respectively. The ROC was higher for women than men(0.81v.s.0.73 for hypertension; 0.87v.s.0.78 for severe hypertension; both P<0.001), and for younger than older participants (0.77v.s.0.72 for hypertension; 0.82v.s.0.76 for severe hypertension; both P<0.05). Baseline venular tortuosity was positively associated with baseline hypertension prevalence (OR:1.57; P=0.01) but not with incident hypertension (P=0.449). Baseline arteriolar tortuosity was associated with neither prevalence nor incidence of hypertension.

Conclusions : Automatically assessed narrower arterioles and wider venules on conventional fundus images indicate an increased risk for incident hypertension within 5 years. Assessment of retinal vessels may help to screen individuals with risk of developing hypertension.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Fig.1 The 5-year incidence of hypertension and severe hypertension shown as its mean value(solid line)±standard error(shade area), stratified by the CRAE(red) and CRVE(green).

 

Fig.2 Receiver operating curves for the retinal vessel calibers to predict the 5-year incident hypertension.