Prevalence Of Hypertensive Retinopathy Research Articles

Incidence and determinants of hypertensive retinopathy in hypertension patients at a teaching hospital in North Western Karnataka

Persistently raised blood pressure not only leads to retinal vascular damage but also leads to systemic diseases. The retinal vasculature observation by fundoscopy offers a great opportunity to explore the association of systemic microvascular disease caused by hypertension. Hypertensive retinopathy (HR) is considered to be a marker for vascular disease and death. The aim of the present study was to find out the prevalence of hypertensive retinopathy among hypertensive subjects and assess the pattern of retinopathy and associated risk factors. This was a hospital based cross-sectional study conducted among hypertensive patients at a teaching hospital, for a period of 3 months.A total of 300 hypertensive patients formed the study population. The prevalence of the hypertensive retinopathy in the present study was 49.33%. Hypertensive retinopathy was more prevalent in men 62% than women 38%. The prevalence of grade 1 and grade 2 hypertensive retinopathies was 43.24% and 33.11% respectively and 20.95% and 2.7% had grade 3 and 4 respectively. The prevalence of retinopathy was found to be statistically higher in patients who had h/o hypertension for more than 5 years. The prevalence of hypertensive retinopathy was more common in age group >60yrs. The prevalence of target organ damage was higher in those having retinopathy.The prevalence of hypertensive retinopathy is high in the present study which reflects lack of awareness, patient compliance, sub optimal measures to control blood pressure and even lack of prompt follow up with ophthalmologists. There is need to spread awareness and take adequate measures to reduce the burden of hypertensive retinopathy.

Hypertensive Retinopathy among Patients with Hypertension Attending the Department of Ophthalmology in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Hypertension is one of the major cardiovascular diseases leading to disability or death. Persistently elevated blood pressure leads to retinal vascular changes, also known as hypertensive retinopathy. The aim of this study was to find out the prevalence of hypertensive retinopathy among patients with hypertension attending the Department of Ophthalmology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among hypertensives patients presenting to the Department of Ophthalmology in a tertiary care centre from 1 June 2022 to 1 February 2023 after receiving ethical approval from the Institutional Review Committee (Reference number: CMC-IRC 078/079-228). Those patients who did not provide informed consent and patients with chronic debilitating systemic conditions, patients encountered in emergency wards, and hypertensive patients below 15 years of age and above 75 years of age were excluded from the study. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 336 study participants, hypertensive retinopathy was found in 66 (19.64%) (15.39-23.89, 95% Confidence Interval) study subjects in at least one eye. Conclusions: The prevalence of hypertensive retinopathy was lower in our study when compared to other studies.

Prevalence of hypertensive retinopathy among the known diabetics in a community-based setting using a non-mydriatic fundus camera

Hypertension is a leading cause of morbidity and mortality and is associated with the risk of cardiovascular, cerebrovascular disease, and target organ damage. The risk increases exponentially in individuals with diabetes. Hypertensive retinopathy is a marker for target organ damage, so screening for hypertensive retinopathy helps in cardiovascular risk stratification. This study was conducted with an objective to screen for hypertensive retinopathy among known diabetics using a portable non-mydriatic fundus camera to ascertain its prevalence. The study was conducted in three selected field practice areas of the Department of Community Medicine. A house-to-house survey was performed using a predesigned, pretested questionnaire among 302 known diabetics. The study participants were subjected to visual acuity examination using Snellen's chart and retinal fundus examination using a portable non-mydriatic Bosch Mobile Eye Care Solutions fundus camera. The fundus images were transferred to a laptop and were reviewed and graded by an experienced Ophthalmologist. Among the 302 participants studied, 60 were diagnosed with hypertensive retinopathy. The prevalence of hypertensive retinopathy among diabetic patients was 19.9 % (95% CI: 15.7% - 24.6%). The prevalence was found to be higher in ** (21.8%; 95% CI: 16% - 28.6%) as compared to ** (17.5%; 95% CI: 11.8% - 24.6%). Early detection of hypertensive retinopathy with cardiovascular risk stratification and initiation of prompt treatment among the high-risk individuals will help reduce the morbidity caused due to end-organ damage and premature mortality to a greater extent and will pave the way forward to achieving sustainable developmental goals.

SERUM BIOMARKERS OF LIPID, ATHEROGENIC INDEX OF PLASMA, ELECTROCARDIOGRAM AND FUNDUS CHANGES IN HYPERTENSIVE PATIENTS OF CENTRAL NEPAL

Background: Hypertensive retinopathy, its ocular complication, is characterized by progressive metabolic disorders and structural damage to the retina. Lipids play an essential role in retinal hemostasis. The study was aimed to assess the prevalence of hypertensive retinopathy, the association between traditional lipid biomarkers and hypertensive retinopathy, and the predictive risk for future cardiac events using the atherogenic index of plasma in hypertensive patients of central Nepal. Methods: A hospital-based cross-sectional study was conducted in the Department of Ophthalmology, Chitwan Medical College, from 15 August 2021 to 30 October 2021. Ethical clearance was taken from the Institutional Review Committee (Ref: CMC-IRC/078/079-025). Convenience sampling was done to reach the sample size. Relevant data was entered in a proforma specified for the study. Data analysis was done using Statistical Package for the Social Sciences version 26, point estimate at 95% Confidence Interval (CI) was calculated along with frequency and proportion for binary data, p-value <0.05 was considered statistically significant. Results: The prevalence of hypertensive retinopathy was 34 (10.7%) (7.5-14.6 at 95% CI) in the study subjects. Gender wise females 167 (52.7%) outnumbered the males 150 (47.3%). Serum cholesterol level was the only biomarker significantly associated with the development of hypertensive retinopathy (p = 0.01). The mean atherogenic index of plasma in the study subjects was high (0.52). Conclusions: The prevalence of hypertensive retinopathy was lower in this study than similar studies done elsewhere. The atherogenic index of plasma was higher in the study subjects.

Association between blood pressure classification using the 2017 American College of Cardiology/American Heart Association blood pressure guideline and hypertensive retinopathy

Abstract Purpose We aimed to explore the association of blood pressure (BP) classification using the 2017 American College of Cardiology/ American Heart Association Guideline and the prevalence of hypertensive retinopathy using a nationwide epidemiological database. Methods This study is a retrospective observational cross-sectional analysis using the health claims database of the JMDC between 2005 and 2020. We analyzed 280,599 participants who did not take anti-hypertensive medications. Each participant was categorized as having normal BP (systolic BP [SBP] <120 mm Hg and diastolic BP [DBP] <80 mm Hg; n=159,524); elevated BP (SBP 120–129 mm Hg and DBP <80 mm Hg; n=35,603); stage 1 hypertension (SBP 130–139 mm Hg or DBP 80–89 mm Hg; n=54,795); or stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg; n=30,677). Retinal photography at health check-up was classified as normal, grade 1, grade 2, grade 3, or grade 4 according to the Keith-Wagener-Barker system. Results Median (interquartile range) age was 46 (40–53) years, and 50.4% were men. Hypertensive retinopathy which was defined as ≥ Keith-Wagener-Barker system grade 1, was observed in 16,836 participants (6.0%). Multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23–1.38), stage 1 hypertension (OR 1.71, 95% CI 1.64–1.79), and stage 2 hypertension (OR 4.10, 95% CI 3.93–4.28) were associated with higher prevalence of hypertensive retinopathy. Even among 92,121 participants without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol drinking, multivariable logistic regression analysis showed that, compared with normal BP, elevated BP (odds ratio 1.34, 95% CI 1.19–1.51), stage 1 hypertension (OR 1.79, 95% CI 1.61–1.98), and stage 2 hypertension (OR 4.42, 95% CI 4.00–4.92) were associated with higher prevalence of hypertensive retinopathy. The association between BP category and hypertensive retinopathy was observed in all subgroups stratified by age or sex. Conclusion Our investigation showed that the prevalence of hypertensive retinopathy increased with the blood pressure category, suggesting that atherosclerotic change could start even in elevated BP and stage 1 hypertension. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).

Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients in a Tertiary Hospital of Gandaki Province of Nepal

Introduction: Hypertensive retinopathy is one of the major complications of hypertension. The presence of hypertensive retinopathy may be an indicator of the presence of other complications too. This study aimed to determine the prevalence and risk factors of hypertensive retinopathy in hypertensive patients in a tertiary care hospital in Nepal. Methods: This was a hospital-based cross-sectional study conducted among 95 hypertensive patients aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and hypertensive retinopathy was graded according to Keith-Wagener-Barker classification. Statistical analysis was carried out using Epi-info 7. Results: The mean age of the study sample was 59.74±15.11 years. The prevalence of hypertensive retinopathy was 38.95%. Among the patients with hypertensive retinopathy, the prevalence of grade I, II, III, and IV retinopathies were 7.36%, 17.89%, 10.52%, and 3.15% respectively. There was a statistically significant association between hypertensive retinopathy and controlled blood pressure and treatment of hypertension. However, there was no statistically significant association between hypertensive retinopathy and gender, duration of hypertension, residence, family history, history of smoking, and diet. Conclusion: Uncontrolled blood pressure and untreated patients of hypertension were the significant risk factors for hypertensive retinopathy. Early diagnosis and treatment of hypertension are essential to prevent loss of vision.

Hypertensive retinopathy and associated factors among nondiabetic chronic kidney disease patients seen at a tertiary hospital in Tanzania: a cross-sectional study.

Background: Hypertensive retinopathy is a known marker of cardiovascular disease, and among unselected patients with chronic kidney disease (CKD) more severe retinopathy has been associated with lower estimated glomerular filtration rate (eGFR). This association has, however, not been widely studied among nondiabetic hypertensive patients with CKD, especially in sub-Saharan Africa. We aimed to determine the prevalence and severity of hypertensive retinopathy and its relationship with eGFR among nondiabetic CKD patients seen at Muhimbili National Hospital in Dar es Salaam, Tanzania.Methods: A hospital-based cross-sectional study was conducted among nondiabetic CKD adult (≥18 years) patients with hypertension. A structured questionnaire was used to record patients’ demographic characteristics and their cardiovascular risk profile. eGFR was calculated using the Modification of Diet in the Renal Disease (MDRD) equation and only patients with CKD stage 3 or more were enrolled in the study. Grading of retinopathy was done using the Keith–Wagener classification.Results: In total, 224 patients fulfilled the inclusion criteria and were enrolled. Their mean age was 45.8±14.1 years, and 59.4% were men. The proportions of patients with stage 3, 4, and 5 CKD were 21.4%, 19.6%, and 58.9%, respectively. Hypertensive retinopathy was present in 157 (70.1%) patients and the proportions with grade I, grade II, grade III, and grade IV retinopathy were 17.9%, 18.8%, 19.6%, and 13.8%, respectively. The severity of retinopathy increased with decreasing levels of eGFR, and in multivariate logistic regression analysis, factors found to be independently associated with ≥grade II hypertensive retinopathy were more severe CKD, higher hypertension grades, and alcohol use, all p<0.05.Conclusion: The prevalence of hypertensive retinopathy is high among nondiabetic CKD patients seen at a tertiary hospital in Tanzania and is independently associated with CKD severity. Retinopathy grade can be used as a marker of CKD severity among these patients.

Profile of Hypertensive Retinopathy in a Tertiary Centre in Western Nepal

Objective: The present study was done to find out prevalence of hypertensive retinopathy among patients attending in OPD in GMC.&#x0D; Methods: A hospital based cross-sectional study was performed among 200 hypertensive patients visiting eye OPD from Dec 2016 to Dec 2017. Detailed eye examination including fundus evaluation under mydriasis was done on all subjects and hypertensive retinopathy was graded according to Keith, Wagner and Barker classification by ophthalmologist using 90 dioptre lens. Patient having diabetes and other retinal diseases were excluded from the study. Data analysis was done using spss software.&#x0D; Results: The mean age of the patients was 60.58 ±12.26 standard deviation. In our study 56.5% patients had hypertensive retinopathy. Of which 31% had grade I, 19% had grade II, 6% had grade III and 0.5% had grade IV hypertensive retinopathy. The ratio of hypertensive retinopathy among male and female was 1.7:1.&#x0D; Conclusion: Hypertensive retinopathy is common among hypertensives and males are more prone to retinopathy than females.

A study of prevalence of hypertensive retinopathy at tertiary health care center

A study of prevalence of hypertensive retinopathy at tertiary health care center

Retinal imaging to identify target organ damage in older Africans: A pilot study.

By 2030, sub-Saharan Africa is forecast to see the steepest rise in the number of people with hypertension of any world region. Hypertensive retinopathy is known to be a common complication of hypertension in developed countries and some studies suggest it is associated with the presence of other hypertension-related end-organ damage (EOD) such as stroke and cardiovascular disease. In Tanzania hypertension is relatively more common than in other parts of sub-Saharan Africa, especially in the older population; however, the prevalence of hypertensive retinopathy and its association with EOD remain unknown. The authors conducted a cross-sectional study of elderly, community-dwelling, rural Tanzanians to determine the prevalence of hypertensive retinopathy and its association with hypertension and other forms of EOD. Hypertensive retinopathy was diagnosed based on retinal imaging. In a cohort of 61 patients with gradable images, the authors found the overall prevalence of hypertensive retinopathy to be 64% (n=39), which was strongly associated with hypertension (X2 [1]=4.207, P=.004), with a significant trend towards more severe retinopathy with more severe hypertension (r=.377, P=.003). The authors did not find hypertensive retinopathy to be associated with other forms of EOD. Hypertensive retinopathy is highly prevalent in this population and is associated in most but not all cases with hypertension. These findings do not suggest that it could be used as a screening tool for EOD, but it is important to identify and educate patients with retinopathy about possible complications of the condition.

Serum uric acid concentration is associated with hypertensive retinopathy in hypertensive chinese adults

BackgroundThis cross sectional investigation included 12,966 subjects with hypertension, a cohort of the China Stroke Primary Prevention Trial (CSPPT), a randomized, multicenter clinical trial. This study aimed to explore the correlation between serum uric acid (SUA) concentration and hypertensive retinopathy in hypertensive adults.MethodsDiagnosis of hypertensive retinopathy was determined by non-mydriatic fundus photography and classified with Keith-Wagener-Barker (KWB) system. The correlation of SUA levels with hypertensive retinopathy prevalence and severity was assessed by statistical analysis.Results9848 (75.95%) subjects were diagnosed with hypertensive retinopathy with the following retinopathy grade distribution: grade 1: 58.80%, grade 2: 14.81%, and grade 3–4: 2.34%. SUA levels were significantly associated with hypertensive retinopathy prevalence. Patients with hypertensive retinopathy had higher SUA levels than those without hypertensive retinopathy. Patients in the highest uric acid quartile had an odds ratio for hypertensive retinopathy of 1.21 compared to patients in the lowest uric acid quartile (OR = 1.21, 95% CI: 1.05–1.40, P = 0.008). When compared to the non-hyperuricemia group, those in the hyperuricemia group had an odds ratio for hypertensive retinopathy of 1.18(OR = 1.18, 95% CI: 1.05–1.33, P = 0.004). Every 1 mg/dl increase in uric acid concentration was significantly associated with a 6% higher odds of hypertensive retinopathy (OR = 1.06, 95% CI: 1.02–1.10, P = 0.002).ConclusionsThe prevalence of hypertensive retinopathy was high (75.95%) among hypertensives in our patients cohort. In addition, SUA concentration was significantly associated with hypertensive retinopathy.

AB0575 Ocular Findings in Takayasu's Arteritis is Milder in A Turkish Series

BackgroundTakayasu's arteritis (TAK) is an inflammatory, granulomatous vasculitis affecting aorta and its major branches. According to the type of vascular involvement, Takayasu's retinopathy (TR) and hypertensive retinopathy (HR) may be...

Prevalence of Hypertensive Retinopathy in Prince Zaid Bin Al-Hussein Hospital

Prevalence of Hypertensive Retinopathy in Prince Zaid Bin Al-Hussein Hospital

Racial differences in the prevalence of hypertensive retinopathy

The higher prevalence of systemic hypertension in African Americans compared with white persons in the US is well documented. Studies have shown that African Americans are more likely to develop hypertensive-related complications (such as left ventricular hypertrophy, stroke, hypertensive kidney disease) and to have higher mortality rates. However, few population-based data support the hypothesis that hypertensive retinopathy is more common in African Americans than in whites. The authors examined racial differences in the prevalence of and risk factors for hypertensive retinopathy in a population-based sample of 1860 African Americans and 7874 white persons, aged 49 to 73 years, without diabetes (participants in the ARIC study). Retinal photographs were taken of one randomly selected eye and evaluated for the presence of retinopathy (flame and blot-shaped retinal hemorrhages, microaneurysms, and soft exudates) according to standardized protocols by graders masked to participant characteristics. The prevalence of retinopathy was 2 times higher in African Americans than in whites (7.7% versus 4.1%, age- and gender-adjusted odds ratio [OR] 2.03, 95% confidence intervals [CI] 1.65, 2.49). After controlling for 6-year mean arterial blood pressure, use of antihypertensive medications and left ventricular hypertrophy by ECG criteria, the excess prevalence of retinopathy in African Americans was reduced by 40% (adjusted OR 1.61, 95% CI 1.26, 2.06). Further adjustment for other vascular risk factors, common carotid artery intima-media thickness, and serum creatinine levels reduced the excess prevalence in African Americans by another 13% (adjusted OR 1.48, 95% CI 1.08, 2.03). The authors conclude that hypertensive retinopathy is twice as frequent in African Americans compared with whites without diabetes and that the excess prevalence of retinopathy in African Americans is associated with blood pressure and severity of hypertension.—Valérie Biousse

Racial differences in the prevalence of hypertensive retinopathy

Racial differences in the prevalence of hypertensive retinopathy

Retinopatia hipertensiva: revisão

O presente estudo faz uma revisao do tema retinopatia hipertensiva. Para tanto propos-se uma breve revisao dos dados historicos da retinopatia hipertensiva. Este estudo relata as alteracoes classicas da retinopatia hipertensiva e suas classificacoes, bem como os achados mais recentes associados a hipertensao arterial sistemica, os provaveis mecanismos fisiopatologicos e as alteracoes histologicas associadas a retinopatia hipertensiva. Abordamos, ainda, os diversos metodos utilizados para a investigacao, suas vantagens e desvantagens; uma visao critica da interpretacao dos sinais do envolvimento do bulbo ocular pela hipertensao arterial sistemica; ainda, baseado na diversidade das metodologias de investigacao da retinopatia, comenta-se a repercussao desta, na prevalencia da retinopatia hipertensiva e suas implicacoes, como orgao-alvo da hipertensao arterial sistemica, em um contexto atualizado da sindrome metabolica e de outros fatores associados a fisiopatologia da HAS, como a leptina e a endotelina.

Hipertensão e retinopatia hipertensiva

Objetivo: Avaliar a prevalência de retinopatia hipertensiva (RH) em pacientes hipertensos (controlados e não controlados) e normotensos na população acima dos 40 anos do município de Piraquara. Correlacionar os casos de alteração retiniana com o sexo, a raça e a idade do paciente. Métodos: Durante 1998 e 2000, foram examinados no Projeto Glaucoma da Universidade Federal do Paraná 1.954 pacientes. Destes, excluíram-se aqueles abaixo de 40 anos e os diabéticos, sendo que a população considerada para este estudo foi de 1.741 pacientes. O protocolo do projeto consiste de anamnese direcionada, aferição da pressão arterial (PA), glicemia por tiras reativas, PIO e fundoscopia direta e indireta. As alterações fundoscópicas pertinentes a retinopatia hipertensiva foram estudadas segundo a classificação de Gans e correlacionadas conforme mencionado anteriormente. Resultados: Dos 1.741 pacientes analisados, 669 (38,43%) são hipertensos, 645 (37,05%) normotensos e 427 (24,53%) suspeitos de hipertensão arterial sistêmica (HAS). Foram encontrados 211 (12,12%) pacientes com sinais de RH, sendo 136 (64,46%) do sexo feminino e 75 (35,54%) do sexo masculino; 134 (63,98%) de 40 a 60 anos e 77 (36,02%) com idade superior a 60 anos; predominando as raças branca (75,83%) e negra (11,37%). Do total de pacientes com RH, 154 (73%) eram hipertensos, 17 (2,64%) normotensos e 40 (9,37%) suspeitos de HAS. Dentre os hipertensos com PA controlada, 12,2% apresentavam sinais de retinopatia. Já dentre os hipertensos com PA não controlada, 25,3% apresentavam sinais da patologia. Conclusão: A prevalência de RH foi maior nos hipertensos comparativamente aos normotensos e suspeitos de HAS (p<0,001, OR=5,32). Os pacientes negros (p<0,05 e OR= 1,67), os hipertensos com PA não controlada (p<0,01, OR=2,44) e os acima de 60 anos (p<0,001, OR=1,85) apresentaram maiores chances de desenvolverem RH.

Association between salt sensitivity and target organ damage in essential hypertension

Cardiovascular events occur more frequently in sodium-sensitive patients with essential hypertension; recently, sodium sensitivity was shown to be a cardiovascular risk factor independently of other classic factors such as blood pressure and cigarette smoking This study examined the relationship between salt sensitivity status and target organ damage in hypertensive patients. Ninety-six patients (35 men, 61 women) with moderate essential hypertension were studied for salt sensitivity status and the presence of target organ damage, including hypertensive retinopathy, serum creatinine, creatinine clearance, and urinary albumin excretion (UAE). Four different patterns of left ventricular anatomic adaptation were identified by categorizing patients according to the values of left ventricular mass index and relative wall thickness by the means of echocardiography. Forty-five (47%) patients were shown to be salt-sensitive, in contrast to 51 (53%) salt-resistant subjects. Serum creatinine and UAE were significantly higher in the group of salt-sensitive hypertensives ( P < .05 and P < .001, respectively). Left ventricular mass index (LVMI), relative wall thickness (RWT), and left atrial index (LAI) were all significantly higher in the group of salt-sensitive hypertensive patients. Concentric hypertrophy was significantly more prevalent in the salt-sensitive group (37.8% v 11.8%; P < .01). The prevalence of hypertensive retinopathy in the salt-sensitive group was 84.4%, in contrast to 59.6% in the salt-resistant group ( P < .01). Multivariate regression analysis revealed salt sensitivity as a significant predictor of LVMI, RWT, and UAE, independently of age, body mass index, and mean blood pressure. In conclusion, salt-sensitive hypertensive patients are more prone to develop severe hypertensive target organ damage that may enhance their risk of renal and cardiovascular morbidity.

Clinical Implications of White Coat Hypertension

To determine the clinical implications of mild white coat hypertension (WCH). We studied 102 subjects (54 men, 48 women), 51 of whom were normotensive and 51 slightly hypertensive. None had ever received antihypertensive therapy. An ambulatory blood pressure (ABP) record (Accutracker II), a 24-h electrocardiogram and an echocardiogram were obtained from each, and each was examined by funduscopy. WCH subjects were compared with sustained hypertension (SH) subjects and with normotensives. Fifty-three percent of the hypertensives qualified as WCH. The ultrasonographic characteristics and the ABP variables of the WCH group differed significantly from those of normotensives, but not from those of the SH group. The prevalence of left ventricilar hypertrophy (LVH) in the SH group (62.5%) did not differ significantly from its prevalence in the WCH group (40.7%), but the prevalence among normotensives (17.6%) was significantly lower than in either of the other two groups. The WCH and SH groups did not differ significantly as regards the prevalence of hypertensive retinopathy (33.3% in the former, 58.3% in the latter). For no non-LVH, non-retinopathic subject, whether normotensive or hypertensive, were more than 18% of daytime diastolic ABP measurements > or = 90 mmHg. Ultrasonographic findings were no better correlated with ABP than with in-clinic BP measurements. Fundus findings correlated well with in-clinic BP and with numerous ABP parameters. Retinopathy, with or without LVH, was efficiently predictable among hypertensives on the basis of body mass index and the 24-h maximum of systolic BP. Myocardiac remodelling and vascular retinopathy develop early and in parallel in hypertensives, and both developments appear to involve determinants including body mass index and 24-h maximum systolic BP. WCH subjects, as defined by current ABP-based criteria, have cardiac and retinovascular characteristics different to normotensive subjects. Stricter criteria are needed to discriminate between hypertensives with and without the systemic developments that constitute the immediate source of risk to the hypertensives individual.