Retinopathy predicts risk of stroke in hypertensive patients

While it is known that hypertension increases the risk of stroke, it is unclear which associated risk factors may predict its occurrence. Research published in the August issue of Hypertension found that retinopathy may be one of those predictive risks.

“Hypertensive retinopathy predicts the long-term risk of stroke, independent of blood pressure, even in treated patients with hypertension with good hypertension control,” wrote the authors, led by Yi-Ting Ong, a graduate student at the National University of Singapore.

They utilized research participants who were part of the Atherosclerosis Risk in Communities (ARIC) Study. ARIC is a prospective epidemiologic community-based study investigating the cause and outcomes of atherosclerosis in four U.S. communities. The participants are re-examined every three years and receive yearly telephone follow-ups. Ong and his colleagues included 2,907 individuals who participated in ARIC between 1993 and 1996.

After looking at retinal photographs, they classified retinopathy as either none, mild or moderate/severe. A total of 1,406 participants had hypertensive retinopathy, and after a follow-up period averaging about 13 years, 165 had strokes. There were 146 cerebral infarctions and 15 hemorrhagic strokes.

After they adjusted for risk factors, people with moderate hypertensive retinopathy were more likely to have a stroke (hazard ratio of 2.37).

Retinopathy increased stroke risk even if participants had their hypertension under control. Their risk of cerebral infarction was increased (hazard ratio of 1.96 for mild retinopathy and 2.98 for moderate).

They concluded that “the presence of these retinal microvascular changes is indicative of additional vascular risk beyond that conferred by traditional cardiovascular risk factors.”

Their findings suggest retinal examinations may be warranted in hypertensive patients.

“[F]undus [retinal] examination may potentially provide additional information on long-term stroke risk stratification,” they wrote.