CLINICAL SCIENCE

Hypertensive retinopathy and incident coronary heart disease in high risk men

B B Duncan¹, T Y Wong², H A Tyroler³, C E Davis⁴ and F D Fuchs⁵

¹ Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
² Department of Ophthalmology, National University of Singapore, and Singapore National Eye Centre and Singapore Eye Research Institute, Singapore
³ Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA
⁴ Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC, USA
⁵ Internal Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil

Correspondence to:
Correspondence to:
Tien Yin Wong, Department of Ophthalmology, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260;
ophwty{at}nus.edu.sg

Background/aim: Although routine ophthalmoscopy is recommended in the evaluation of people with hypertension, the prognostic significance of retinopathy is unknown. The purpose of this study is to determine if hypertensive retinopathy predicts coronary heart disease (CHD).

Methods: A prospective cohort study involving 560 hypertensive, hyperlipidaemic, middle aged men enrolled in the Lipid Research Clinic’s Coronary Primary Prevention Trial. Signs of hypertensive retinopathy (generalised and focal arteriolar narrowing, arteriovenous nicking, widened arteriolar light reflex, retinal haemorrhage and exudates, microaneurysms, and disc swelling) were evaluated by direct funduscopy during a baseline examination by study physicians. Incident CHD events were ascertained from hospital records, necropsy reports, and death certificates, and reviewed by a masked panel of cardiologists.

Results: There were 51 definite CHD events (definite CHD deaths or myocardial infarctions) during a median follow up of 7.8 years. After adjusting for age, blood pressure, electrocardiographic manifestations of left ventricular hypertrophy, cholesterol levels and treatment, glucose and creatinine levels, and smoking status in proportional hazards analysis, the presence of hypertensive retinopathy predicted a doubling of the risk of definite CHD events (relative risk 2.1; 95% confidence interval (CI) 1.0 to 4.2 ). The presence of either generalised or focal arteriolar narrowing predicted almost a tripling of the risk (relative risk 2.9; 95% CI 1.3 to 6.2). Associations were similar for stage 1 hypertension (systolic and diastolic blood pressures of 140–159 and 90–99 mm Hg, respectively) and for other CHD end points.

Conclusion: Hypertensive retinopathy predicts CHD in high risk men, independent of blood pressure and CHD risk factors. The data support the concept that retinal microvascular changes are markers of blood pressure damage and may be useful in risk stratification and in the tailoring of hypertension treatment decisions.

Keywords: hypertensive retinopathy; coronary heart disease; men

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