Hypertensive Retinopathy and Risk of Cardiovascular Diseases in a National Cohort

Background:

Retinal vascular examination using direct ophthalmoscopy can be used to determine the extent of hypertensive vascular changes. We studied the association of these changes in a large national cohort.

Methods:

First National Health and Nutrition Survey (NHANES I) was conducted from 1971 through 1975. A subgroup (n=5500) of participants aged 25 to 74 years received standardized ophthalmologic examination and hypertensive changes were documented. Participants of the study had follow-up interviews and examinations up to 1992. All health care facility records and death certificates were ascertained and reviewed. Participants who were admitted with or died of primary diagnosis of either ischemic stroke or coronary heart disease were identified. We used Cox proportional-hazards regression to study the association of hypertensive retinopathy with cardiovascular disease.

Results:

After excluding patients with previous history of stroke or myocardial infarction and/or missing blood pressure information, 4753 participants were included in the analysis. Participants with hypertensive retinopathy were older (61 ± 11 vs 47 ± 15) and more likely to be men (54% vs 62%). After adjustment for age, sex, race/ethnicity, body-mass index, cigarette smoking, systolic blood pressure, cholesterol, and diabetes mellitus patients with hypertensive retinopathy had a relative risk (RR) of 1.2 (95% confidence interval [CI] 1.0 – 1.3) for any cardiovascular disease and RR of 1.2(95% CI 0.9–1.5) for ischemic stroke.

Conclusion:

The presence of hypertensive retinal vascular changes is associated with increased risk of cardiovascular disease. Identification of such changes in the clinical setting can be used for stratification of high risk patients.