Mild Hypertensive Retinopathy Research Articles

Hypertensive retinopathy and cardiovascular disease risk: 6 population-based cohorts meta-analysis

BackgroundThe cardiovascular risk associated with different levels of hypertensive retinopathy, including mild, remains unclear. We performed an individual participant meta-analysis from 6 population-based cohort studies to determine the relationship of hypertensive retinopathy with incident cardiovascular outcomes. MethodsWe identified cohort studies that objectively assessed hypertensive retinopathy from photographs, documented incident cardiovascular outcomes, and were population-based. Six studies contributed data from 11,013 individuals at baseline with 5–13 years follow-up. Participants were recruited if they had hypertension and did not have confounding conditions such as diabetic retinopathy. Main outcome measures were incident coronary heart disease (CHD), stroke and a composite endpoint of cardiovascular disease (CHD or stroke). Pooled estimates of incident risk ratios (IRR) were obtained after adjusting for age, gender, systolic blood pressure, serum total cholesterol, high density lipoprotein and smoking. ResultsAmong eligible participants with hypertension and without diabetes, there were 1018/9662 (10.5%) incident CHD events, 708/11,013 (6.4%) incident stroke events and 1317/9378 (14.0%) incident CVD events. Mild hypertensive retinopathy was associated with increased risk of CVD (IRR 1.13, 95% CI 1.00 to 1.27) and CHD (IRR 1.17, 95% CI 1.02 to 1.34) but not stroke; moderate hypertensive retinopathy was associated with increased risk of CVD (IRR 1.25 95% CI 1.02 to 1.53) but not stroke or CHD individually. ConclusionsIn persons with hypertension, both mild and moderate hypertensive retinopathy were associated with higher CVD risk.

Mild Hypertensive Retinopathy and Risk of Cardiovascular Disease: The Suita Study.

This study aimed to investigate the association of mild hypertensive retinopathy with cardiovascular disease (CVD) risk. A total of 7,027 residents aged 30-79 years without a history of CVD participated in the annual health checkups and retinal photography assessments. Retinal microvascular abnormalities were graded using the standard protocols and classified according to the Keith-Wagener-Barker classification. Mild hypertensive retinopathy was defined as grades 1 and 2. Cox proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for total CVD and its subtypes according to the presence and absence of mild hypertensive retinopathy. During a median follow-up of 17 years, 351 incident stroke and 247 coronary heart disease (CHD) cases were diagnosed. After adjustment for traditional cardiovascular risk factors, mild hypertensive retinopathy was positively associated with risk of CVD (multivariable HR=1.24; 95% CI, 1.04-1.49) and stroke (1.28; 1.01-1.62) but not with risk of CHD (1.19; 0.89-1.58). Generalized arteriolar narrowing and enhanced arteriolar wall reflex were positively associated with CVD risk, the multivariable HR (95% CI) was 1.24 (1.00-1.54) and 1.33 (1.02-1.74), respectively. Moreover, mild hypertensive retinopathy was positively associated with stroke risk in normotensive participants. Mild hypertensive retinopathy was positively associated with CVD and stroke risk in the urban Japanese population. Especially, generalized arteriolar narrowing and enhanced arteriolar wall reflex were positively associated with CVD risk. These findings suggested that retinal photography could be helpful for cardiovascular risk stratification in the primary cardiovascular prevention.

Primary Vitreoretinal Lymphoma: A Retrospective Study of 20 Eyes.

Purpose This study aimed to describe and analyze the clinical features of 20 eyes of 15 primary vitreoretinal lymphoma (PVRL) patients. Methods This was a retrospective case series and a review of the literature. Fifteen PVRL patients (20 affected eyes) referred between February 2011 and December 2019 were recruited, and their medical records were retrospectively reviewed. Results Among these 15 PVRL patients, seven were men (46.67%), and five had bilateral PVRL (33.33%). The median onset age was 66 ± 9.26 years and six (40%) patients had central nervous system (CNS) involvement, and two of them died of CNS-related complications. The ocular symptoms varied from decreased vision to binocular diplopia. The ocular manifestations were diverse and involved both the anterior and posterior segments, including the vitreous cells, subretinal white-yellow lesions, cotton-wool spots, and ophthalmoplegia. The rate of misdiagnosis and failure to diagnose was 100%, and 30% of them were misdiagnosed as uveitis. We found five cases revealing rare characteristics of this malignancy. Among them, there were two cases with mild hypertensive retinopathy exhibiting cotton-wool spots, one case mimicking age-related macular degeneration (AMD), one case with systemic lupus erythematosus (SLE), and one patient had extraocular muscle involvement. To the best of our knowledge, we reported PVRL exhibiting cotton-wool spots as the main manifestation and coexisting with extraocular myopathy for the first time. Conclusions PVRL is a rare intraocular malignancy that commonly masquerades as uveitis. As the clinical signs and symptoms are atypical, ophthalmologists must carefully examine patients to avoid misdiagnosis or a failure to diagnose. Cotton-wool spots and extraocular myopathy might be the dominant initial symptoms in PVRL patients, and AMD should be considered a differential diagnosis of PVRL. SLE patients under immunosuppressive treatment could have spontaneous PVRL.

Microvascular retinopathy and angiographically-demonstrated coronary artery disease: A cross-sectional, observational study.

Epidemiological studies suggest retinal microvascular abnormalities predict cardiac events. This study examined microvascular features associated with coronary artery abnormalities. This was a single-centre, cross-sectional, observational study of 144 consecutive subjects undergoing coronary angiography for clinical indications. Their angiograms were deidentified and graded for disease (Leaman score, LAD stenosis ≥ 70%, number of vessels stenosed ≥ 70%), and Thrombolysis in Myocardial Infarction (TIMI) blush score. Subjects also underwent retinal photography (KOWA non-mydriatic camera, Japan), and their deidentified retinal images were graded for hypertensive microvascular retinopathy (Wong and Mitchell classification), vessel calibre using a computer-assisted method (IVAN, U Wisconsin), and diabetic retinopathy (modified Airlie House scheme) independently by a trained grader and an ophthalmologist. Retinal abnormalities were compared between subjects with high and low angiography scores using one way ANOVA, Chi squared and logistic regression analysis (StataCorp, Texas). Subjects had a mean age of 61 years (range 32–88), and included 101 males (70%). Seventeen (12%) had Leaman scores > 10.5, 46 (32%) had LAD stenosis, 13 (9%) had ≥ 3 arteries stenosed, and 20 (14%) had TIMI blush scores < 1. Twenty-six subjects (18%) had a retinal hemorrhage, and 115 (74%) a mild or moderate hypertensive retinopathy. Fifty-five (38%) had diabetes, and 24 (17%) a background (n = 20) or proliferative (n = 4) diabetic retinopathy. A retinal hemorrhage (p = 0.046), moderate microvascular retinopathy (p = 0.08) and proliferative diabetic retinopathy (p = 0.04) were all associated with a higher Leaman score. Venular calibre was increased with triple vessel disease (205.7 ± 21.6 μm, and 193.7 ± 22.3 μm in normals, p = 0.03). Diabetic retinopathy correlated with an increased TIMI blush score (p = 0.01). Retinal microvascular imaging warrants further evaluation in identifying the presence, extent and nature of coronary artery disease.

Epidemiological study of hypertensive retinopathy in the primary care setting: Retrospective cross-sectional review of retinal photographs

Objective The objective is to estimate the prevalence and grading of hypertensive retinopathy in the primary care setting; examine the patient characteristics associated with hypertensive retinopathy; and examine the association of hypertensive retinopathy and other hypertension complications. Methods This is a retrospective cross-sectional study. Subjects included adult hypertensive patients with available and gradable retinal photographs. Results Two hundred fifty-six male hypertensive patients (34.3%) and 491 female hypertensive patients (65.7%) were included. The average duration of hypertension was 7.2 years, and 49.8% and 41.2% of patients were taking one or two antihypertensive medications respectively. Among 1491 qualified retinal photographs (744 right eye and 747 left eye), 24.9%, 62.6%, and 12.5% were classified as showing normal, mild, and moderate hypertensive retinopathy respectively. The three commonest retinal signs were generalized or focal arteriolar narrowing (650 cases, 43.6%), hard exudates (168 cases, 11.3%), and opacity (copper or silver wiring) of the arteriolar wall (166 cases, 11.1%). Patients older than 61 years, having hypertension for more than 15 years, or taking three or more antihypertensive medications were significantly associated with hypertensive retinopathy (P Conclusion In a primary care clinic in Hong Kong, 77.1% of hypertensive patients had hypertensive retinopathy. Advanced hypertensive retinopathy was the commonest target organ damage for hypertensive patients in a primary care clinic.

CAROTID DOPPLER PROFILE IN PATIENT WITH HYPERTENSIVE RETINOPATHY

Background: Retinal vasculature is a unique part of the brain that visualized, which can show microvascular abnormality related to atherosclerosis process. Hypertension can caused vascular sclerosis either in large vessels of carotid or retinal microvasculature which showed in fundoscopic examination. Objective: This study aims to obtain the carotid abnormality with Carotid Doppler ultrasonography in hypertensive retinopathy patients and its contributing factors. Methods: This was a cross-sectional retrospective study using consecutive sampling from Neuro-Ophthalmology Division of Neurology Clinic of Cipto Mangunkusumo Hospital in January to December 2014. All patients, aged 40–80 years old with hypertensive retinopathy and had done Carotid Doppler examination. Hypertensive retinopathy graded according to Wong & Mitchell Classification. Statistical analysis was done using SPSS 15.0 for windows. Results: There were 35 subjects, men slightly more than women with both age mean is 60.5 ± 11.8 years old. Hypertension duration known mostly 10 years or bellow in 27 subjects (77.1%) and uncontrolled blood pressure in 28 subjects (80%). There were 25 subjects (71.4%) with carotid abnormality, mostly non stenotic plaque (54,3%). Mild hypertensive retinopathy occured in 32 subjects (81,4%) and the rest of it were moderate (3 subjects, 8.6%). Conclusion: Fundoscopic abnormality assumed may predict large vessels abnormality, hypertensive retinopathy in this study. This study suggested advanced, more-focused study, larger sample, and analytical method to obtain the correlation between retinal microvasculature and large vessels abnormality, especially carotid artery.

Hypertension-related eye abnormalities

Hypertension affects a significant proportion of the population, however, it is often diagnosed with a delay. The aim of this article is to review the well known and less known eye abnormalities related to hypertension, and place them in the context of population based studies. Hypertension affects various parts of the eye. The originally classified hypertensive retinopathy (retinal microvascular changes) is still relevant, but new features are visible in cases of controlled hypertension. Signs of mild hypertensive retinopathy are more common than expected occurring in nearly 10–15% of the adult non-diabetic population. Hypertensive retinopathy can be an indicator of other hypertensive complications such as neurologic and cardiac complications. Microvascular changes are reversible in well controlled hypertension. Proper treatment of hypertension can reduce the development and progression of diabetic retinopathy and, thus, visual loss due to severe retinal diseases such as retinal vascular occlusion (artery and vein), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration.Orv. Hetil., 154(45), 1773–1780.

Letter by Triantafyllou et al Regarding Article, “Mild Retinopathy Is a Risk Factor for Cardiovascular Mortality in Japanese With and Without Hypertension: The Ibaraki Prefectural Health Study”

To the Editor: We have read with great interest the work from Sairenchi et al in a large cohort of 87 890 individuals with a mean 14.1 years of follow-up,1 which was long awaited for the establishment of the prognostic value of mild hypertensive retinopathy in terms of actual hard clinical outcomes, including all-cause, total cardiovascular, and total stroke mortality. Given the study's findings, we acknowledge the importance attributed to mild hypertensive retinopathy as an independent risk factor for cardiovascular mortality in individuals with and without hypertension. Yet we believe that this conclusion (reproduced in the article's title) might be somewhat …

Letter by Cheung et al Regarding Article, “Mild Retinopathy Is a Risk Factor for Cardiovascular Mortality in Japanese With and Without Hypertension: The Ibaraki Prefectural Health Study”

To the Editor: The Ibaraki Prefectural Health Study shows that mild hypertensive retinopathy signs are independent predictors of cardiovascular mortality among Japanese men and women, with or without hypertension.1 Although this is the largest study to date examining the link between retinal signs and mortality, some aspects of the study merit clarification and further discussion. For instance, there are several noteworthy issues related to the methodology used for retinal grading. First, to grade hypertensive retinopathy, the authors used the Keith-Wagner-Barker classification scheme, which has known major limitations.2 Based on the strength of the reported associations between retinopathy …

Do microvascular retinal changes improve cardiovascular risk estimation?

Do microvascular retinal changes improve cardiovascular risk estimation?

Mild Retinopathy Is a Risk Factor for Cardiovascular Mortality in Japanese With and Without Hypertension

Background— It is unclear whether mild hypertensive retinopathy is a risk factor for mortality. This study examined whether mild hypertensive retinopathy could be a risk factor for cardiovascular mortality in subjects with and without hypertension. Methods and Results— In this cohort study, 87 890 individuals (29 917 men and 57 973 women) 40 to 79 years of age in 1993 were followed up until 2008. Retinal photography was classified as normal, grade 1, or grade 2 based on the Keith-Wagener-Barker system. Risk ratios for all-cause and cause-specific mortality for each classification were calculated with Cox proportional hazards regression models. Covariates included age, systolic blood pressure, antihypertensive medication use, and other cardiovascular risk factors. Multivariable hazard ratios for total cardiovascular disease mortality were 1.24 (95% confidence interval [CI], 1.12–1.38) and 1.23 (95% CI, 1.03–1.47) for grades 1 and 2 among men and 1.12 (95% CI, 1.01–1.24) and 1.44 (95% CI, 1.24–1.68) for grades 1 and 2 among women, respectively. Hazard ratios for total stroke mortality were 1.31 (95% CI, 1.13–1.53) and 1.38 (95% CI, 1.08–1.77) for grades 1 and 2 among men and 1.30 (95% CI, 1.12–1.50) and 1.70 (95% CI, 1.36–2.11) for grades 1 and 2 among women, respectively. For both hypertensive and normotensive subjects of each sex, multivariable hazard ratios for all-cause mortality, total cardiovascular mortality, and total stroke mortality were significantly higher for grade 1 or 2 compared with normal. Conclusions— Mild hypertensive retinopathy is a risk factor for cardiovascular mortality independently of cardiovascular risk factors among men and women with and without hypertension.

How does hypertension affect your eyes?

Hypertension has profound effects on various parts of the eye. Classically, elevated blood pressure results in a series of retinal microvascular changes called hypertensive retinopathy, comprising of generalized and focal retinal arteriolar narrowing, arteriovenous nicking, retinal hemorrhages, microaneurysms and, in severe cases, optic disc and macular edema. Studies have shown that mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population. Hypertensive retinopathy signs are associated with other indicators of end-organ damage (for example, left ventricular hypertrophy, renal impairment) and may be a risk marker of future clinical events, such as stroke, congestive heart failure and cardiovascular mortality. Furthermore, hypertension is one of the major risk factors for development and progression of diabetic retinopathy, and control of blood pressure has been shown in large clinical trials to prevent visual loss from diabetic retinopathy. In addition, several retinal diseases such as retinal vascular occlusion (artery and vein occlusion), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration may also be related to hypertension; however, there is as yet no evidence that treatment of hypertension prevents vision loss from these conditions. In management of patients with hypertension, physicians should be aware of the full spectrum of the relationship of blood pressure and the eye.

Keeping an Eye on Lacunar Infarction

See related article, pages 1349–1355. Mild hypertensive retinopathy independently predicts lacunar infarction, according to a report in this issue of Stroke from the ever-bountiful Atherosclerosis in Communities (ARIC) prospective cohort study.1 It is important news, giving us a new way to explore a poorly understood infarct subtype. Although some might still wonder whether we haven’t known for decades that hypertension leads to lacunar infarction, the story is not so simple. Careful meta-analysis of case-control studies evaluating risk factors for infarct subtypes found only a slightly higher prevalence of hypertension in lacunar compared with nonlacunar infarct cases.2 The observation raises the question: Why do some people with high blood pressure suffer lacunes when others do not? The causal pathway is probably complex, and it bears noting that when C. Miller Fisher connected hypertension to lacunar infarction in 1953, he took pains to clarify that “… hypertension itself does not lead to closure of cerebral vessels ….”3 It makes sense to look at retinal vessels to try to tease out what is happening to cerebral vessels. …

Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality

Hypertensive retinopathy has long been regarded as a risk indicator for systemic morbidity and mortality. New population-based studies show that hypertensive retinopathy signs are strongly associated with blood pressure, but inconsistently associated with cholesterol and other risk factors of atherosclerosis. Mild hypertensive retinopathy signs, such as generalized and focal retinal arteriolar narrowing and arteriovenous nicking, are weakly associated with systemic vascular diseases. Moderate hypertensive retinopathy signs, such as isolated microaneurysms, haemorrhages and cotton-wool spots, are strongly associated with subclinical cerebrovascular disease and predict incident clinical stroke, congestive heart failure and cardiovascular mortality, independent of blood pressure and other traditional risk factors. These data support the concept that an assessment of retinal vascular changes may provide further information for vascular risk stratification in persons with hypertension.

Fluorescein angiography in hypertensive pregnancies

A retrospective study in two university hospitals investigating retinal changes in pregnancies complicated by hypertension, seldom revealed retinal vascular changes in pre-eclamptic toxemia. Fluorescein angiography was performed on 16 severe pre-eclamptic toxemias and 14 chronic hypertension pregnancies. Normal caliber retinal vessels and normal filling time, with no subretinal or subepithelium leakage, was found in all pre-eclamptic toxemic patients. Four out of the 14 chronic hypertensive patients showed signs of mild hypertensive retinopathy. A review of the literature on fluorescein angiography in pregnancy showed that vascular changes in pre-eclamptic toxemia are choroidal rather than retinal.