CLINICAL SCIENCE

Retinal microvascular abnormalities and blood pressure in older people: the Cardiovascular Health Study

T Y Wong^1,2, L D Hubbard², R Klein², E K Marino³, R Kronmal³, A R Sharrett⁴, D S Siscovick⁵, G Burke⁶ and J M Tielsch⁷

¹ Department of Ophthalmology, National University of Singapore and Singapore Eye Research Institute, Singapore
² Department of Ophthalmology, University of Wisconsin, Madison, WI, USA
³ CHS Coordinating Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
⁴ Division of Epidemiology and Clinical Applications, NHLBI, NIH, Bethesda, MD, USA
⁵ Department of Medicine, University of Washington, Seattle, WA, USA
⁶ Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
⁷ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

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

Aim: To examine the relation between blood pressure and retinal microvascular abnormalities in older people.

Methods: The Cardiovascular Health Study is a prospective cohort study conducted in four US communities initiated in 1989 to 1990. Blood pressure was measured according to standardised protocols at each examination. During the 1997–8 examination, retinal photographs were taken of 2405 people aged 69–97 years (2056 without diabetes and 349 with diabetes). Signs of focal microvascular abnormalities (focal arteriolar narrowing, arteriovenous nicking, and retinopathy) were evaluated from photographs according to standardised methods. To quantify generalised arteriolar narrowing, the photographs were digitised and diameters of individual arterioles were measured and summarised.

Results: In non-diabetic people, elevated concurrent blood pressure taken at the time of retinal photography was strongly associated with presence of all retinal microvascular lesions. The multivariable adjusted odds ratios, comparing the highest to lowest quintile of concurrent systolic blood pressure, were 4.0 (95% confidence intervals (CI): 2.4 to 6.9, p test of trend<0.001) for focal arteriolar narrowing, 2.9 (95% CI: 1.6 to 5.3, p<0.001) for arteriovenous nicking, 2.8 (95% CI: 1.5 to 5.2, p<0.001) for retinopathy, and 2.1 (95% CI: 1.4 to 3.1, p<0.001) for generalised arteriolar narrowing. Generalised arteriolar narrowing and possibly arteriovenous nicking were also significantly associated with past blood pressure measured up to 8 years before retinal photography, even after adjustment for concurrent blood pressure. These associations were somewhat weaker in people with diabetes.

Conclusions: Retinal microvascular abnormalities are related to elevated concurrent blood pressure in older people. Additionally, generalised retinal arteriolar narrowing and possibly arteriovenous nicking are related to previously elevated blood pressure, independent of concurrent blood pressure. These data suggest that retinal microvascular changes reflect severity and duration of hypertension.

Keywords: retinal microvascular disease; hypertensive retinopathy; retinal arteriolar narrowing; arteriovenous nicking; blood pressure

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

BJO at a glance

Creig Hoyt
Br. J. Ophthalmol. 2002 86: 945. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Baker, M. L., Wang, J. J., Rogers, S., Klein, R., Kuller, L. H., Larsen, E. K., Wong, T. Y. (2009). Early Age-Related Macular Degeneration, Cognitive Function, and Dementia: The Cardiovascular Health Study. Arch Ophthalmol 127: 667-673 [Abstract] [Full Text]  
• Liew, G., Sharrett, A. R., Wang, J. J., Klein, R., Klein, B. E. K., Mitchell, P., Wong, T. Y. (2008). Relative Importance of Systemic Determinants of Retinal Arteriolar and Venular Caliber: The Atherosclerosis Risk in Communities Study. Arch Ophthalmol 126: 1404-1410 [Abstract] [Full Text]  
• Wang, J. J., Rochtchina, E., Liew, G., Tan, A. G., Wong, T. Y., Leeder, S. R., Smith, W., Shankar, A., Mitchell, P. (2008). The Long-term Relation among Retinal Arteriolar Narrowing, Blood Pressure, and Incident Severe Hypertension. Am J Epidemiol 168: 80-88 [Abstract] [Full Text]  
• Qiu, C., Cotch, M. F., Sigurdsson, S., Garcia, M., Klein, R., Jonasson, F., Klein, B. E.K., Eiriksdottir, G., Harris, T. B., van Buchem, M. A., Gudnason, V., Launer, L. J. (2008). Retinal and Cerebral Microvascular Signs and Diabetes: The Age, Gene/Environment Susceptibility-Reykjavik Study. Diabetes 57: 1645-1650 [Abstract] [Full Text]  
• Sun, C., Liew, G., Wang, J. J., Mitchell, P., Saw, S. M., Aung, T., Tai, E. S., Wong, T. Y. (2008). Retinal Vascular Caliber, Blood Pressure, and Cardiovascular Risk Factors in an Asian Population: The Singapore Malay Eye Study. IOVS 49: 1784-1790 [Abstract] [Full Text]  
• Nguyen, T. T., Wang, J. J., Wong, T. Y. (2007). Retinal Vascular Changes in Pre-Diabetes and Prehypertension: New findings and their research and clinical implications. Diabetes Care 30: 2708-2715 [Full Text]  
• Chao, J. R., Lai, M.-Y., Azen, S. P., Klein, R., Varma, R., the Los Angeles Latino Eye Study Group, (2007). Retinopathy in Persons without Diabetes: The Los Angeles Latino Eye Study. IOVS 48: 4019-4025 [Abstract] [Full Text]  
• Mitchell, P., Cheung, N., de Haseth, K., Taylor, B., Rochtchina, E., Islam, F. M. A., Wang, J. J., Saw, S. M., Wong, T. Y. (2007). Blood Pressure and Retinal Arteriolar Narrowing in Children. Hypertension 49: 1156-1162 [Abstract] [Full Text]  
• Bloomgarden, Z. T. (2007). Diabetic Retinopathy and Diabetic Neuropathy. Diabetes Care 30: 760-765 [Full Text]  
• Kaushik, S., Kifley, A., Mitchell, P., Wang, J. J. (2007). Age, Blood Pressure, and Retinal Vessel Diameter: Separate Effects and Interaction of Blood Pressure and Age. IOVS 48: 557-561 [Abstract] [Full Text]  
• Tikellis, G., Sun, C., Gorin, M. B., Klein, R., Klein, B. E. K., Larsen, E. K. M., Siscovick, D. S., Hubbard, L. D., Wong, T. Y. (2007). Apolipoprotein E Gene and Age-Related Maculopathy in Older Individuals: The Cardiovascular Health Study. Arch Ophthalmol 125: 68-73 [Abstract] [Full Text]  
• Longstreth, W. Jr., Larsen, E. K. M., Klein, R., Wong, T. Y., Sharrett, A. R., Lefkowitz, D., Manolio, T. A. (2007). Associations between Findings on Cranial Magnetic Resonance Imaging and Retinal Photography in the Elderly: The Cardiovascular Health Study. Am J Epidemiol 165: 78-84 [Abstract] [Full Text]  
• Wong, T. Y., Kamineni, A., Klein, R., Sharrett, A. R., Klein, B. E., Siscovick, D. S., Cushman, M., Duncan, B. B. (2006). Quantitative Retinal Venular Caliber and Risk of Cardiovascular Disease in Older Persons: The Cardiovascular Health Study. Arch Intern Med 166: 2388-2394 [Abstract] [Full Text]  
• Taarnhoj, N. C. B. B., Larsen, M., Sander, B., Kyvik, K. O., Kessel, L., Hougaard, J. L., Sorensen, T. I. A. (2006). Heritability of retinal vessel diameters and blood pressure: a twin study.. IOVS 47: 3539-3544 [Abstract] [Full Text]  
• Wong, T. Y., Islam, F. M. A., Klein, R., Klein, B. E. K., Cotch, M. F., Castro, C., Sharrett, A. R., Shahar, E. (2006). Retinal Vascular Caliber, Cardiovascular Risk Factors, and Inflammation: The Multi-Ethnic Study of Atherosclerosis (MESA).. IOVS 47: 2341-2350 [Abstract] [Full Text]  
• Xing, C., Klein, B. E.K., Klein, R., Jun, G., Lee, K. E., Iyengar, S. K. (2006). Genome-Wide Linkage Study of Retinal Vessel Diameters in the Beaver Dam Eye Study. Hypertension 47: 797-802 [Abstract] [Full Text]  
• Shaw, L. J., Bairey Merz, C. N., Pepine, C. J., Reis, S. E., Bittner, V., Kelsey, S. F., Olson, M., Johnson, B. D., Mankad, S., Sharaf, B. L., Rogers, W. J., Wessel, T. R., Arant, C. B., Pohost, G. M., Lerman, A., Quyyumi, A. A., Sopko, G., for the WISE Investigators, (2006). Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies. J Am Coll Cardiol 47: S4-S20 [Abstract] [Full Text]  
• Klein, R., Klein, B. E. K., Knudtson, M. D., Wong, T. Y., Tsai, M. Y. (2006). Are Inflammatory Factors Related to Retinal Vessel Caliber?: The Beaver Dam Eye Study. Arch Ophthalmol 124: 87-94 [Abstract] [Full Text]  
• Cooper, L. S., Wong, T. Y., Klein, R., Sharrett, A. R., Bryan, R. N., Hubbard, L. D., Couper, D. J., Heiss, G., Sorlie, P. D. (2006). Retinal Microvascular Abnormalities and MRI-Defined Subclinical Cerebral Infarction: The Atherosclerosis Risk in Communities Study. Stroke 37: 82-86 [Abstract] [Full Text]  
• Grosso, A, Veglio, F, Porta, M, Grignolo, F M, Wong, T Y (2005). Hypertensive retinopathy revisited: some answers, more questions. Br. J. Ophthalmol. 89: 1646-1654 [Abstract] [Full Text]  
• Wong, T. Y., McIntosh, R. (2005). Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality. Br Med Bull 73-74: 57-70 [Abstract] [Full Text]  
• van den Born, B.-J. H, Hulsman, C. A A, Hoekstra, J. B L, Schlingemann, R. O, van Montfrans, G. A (2005). Value of routine funduscopy in patients with hypertension: systematic review. BMJ 331: 73- [Abstract] [Full Text]  
• Wong, T. Y., Shankar, A., Klein, R., Klein, B. E. K., Hubbard, L. D. (2005). Retinal Arteriolar Narrowing, Hypertension, and Subsequent Risk of Diabetes Mellitus. Arch Intern Med 165: 1060-1065 [Abstract] [Full Text]  
• (2005). Hygieia. J. Epidemiol. Community Health 59: 340-340 [Full Text]  
• Wong, T. Y., Mitchell, P. (2004). Hypertensive Retinopathy. NEJM 351: 2310-2317 [Full Text]  
• Lee, K. E., Klein, B. E. K., Klein, R., Knudtson, M. D. (2004). Familial Aggregation of Retinal Vessel Caliber in the Beaver Dam Eye Study. IOVS 45: 3929-3933 [Abstract] [Full Text]  
• Smith, W., Wang, J. J., Wong, T. Y., Rochtchina, E., Klein, R., Leeder, S. R., Mitchell, P. (2004). Retinal Arteriolar Narrowing Is Associated With 5-Year Incident Severe Hypertension: The Blue Mountains Eye Study. Hypertension 44: 442-447 [Abstract] [Full Text]  
• Wong, T. Y., Duncan, B. B., Golden, S. H., Klein, R., Couper, D. J., Klein, B. E. K., Hubbard, L. D., Sharrett, A. R., Schmidt, M. I. (2004). Associations between the Metabolic Syndrome and Retinal Microvascular Signs: The Atherosclerosis Risk in Communities Study. IOVS 45: 2949-2954 [Abstract] [Full Text]  
• Ikram, M. K., de Jong, F. J., Vingerling, J. R., Witteman, J. C. M., Hofman, A., Breteler, M. M. B., de Jong, P. T. V. M. (2004). Are Retinal Arteriolar or Venular Diameters Associated with Markers for Cardiovascular Disorders? The Rotterdam Study. IOVS 45: 2129-2134 [Abstract] [Full Text]  
• (2004). Hygieia. J. Epidemiol. Community Health 58: 436-436 [Full Text]  
• Wong, T. Y., Knudtson, M. D., Klein, R., Klein, B. E. K., Hubbard, L. D. (2004). A Prospective Cohort Study of Retinal Arteriolar Narrowing and Mortality. Am J Epidemiol 159: 819-825 [Abstract] [Full Text]  
• Knudtson, M D, Klein, B E K, Klein, R, Wong, T Y, Hubbard, L D, Lee, K E, Meuer, S M, Bulla, C P (2004). Variation associated with measurement of retinal vessel diameters at different points in the pulse cycle. Br. J. Ophthalmol. 88: 57-61 [Abstract] [Full Text]  
• Wang, J J, Mitchell, P, Rochtchina, E, Tan, A G, Wong, T Y, Klein, R (2004). Retinal vessel wall signs and the 5 year incidence of age related maculopathy: the Blue Mountains Eye Study. Br. J. Ophthalmol. 88: 104-109 [Abstract] [Full Text]  
• Wong, T. Y., Klein, R., Klein, B. E. K., Meuer, S. M., Hubbard, L. D. (2003). Retinal Vessel Diameters and Their Associations with Age and Blood Pressure. IOVS 44: 4644-4650 [Abstract] [Full Text]  
• Wang, J. J., Mitchell, P., Leung, H., Rochtchina, E., Wong, T. Y., Klein, R. (2003). Hypertensive Retinal Vessel Wall Signs in a General Older Population: The Blue Mountains Eye Study. Hypertension 42: 534-541 [Abstract] [Full Text]  
• Leung, H., Wang, J. J., Rochtchina, E., Tan, A. G., Wong, T. Y., Klein, R., Hubbard, L. D., Mitchell, P. (2003). Relationships between Age, Blood Pressure, and Retinal Vessel Diameters in an Older Population. IOVS 44: 2900-2904 [Abstract] [Full Text]