Mild hypertensive retinopathy (retinal arteriolar signs only)
| Sign | Diagnosis | Histopathology correlations | Clinical correlations | Future research | ||||
|---|---|---|---|---|---|---|---|---|
| Generalised arteriolar narrowing | • Qualitative examination of retinal photographs69,70 • Computer assisted fundus image analysis and AVR calculation in selected standardised portions of the retina16,17 | • Vasoconstrictive phase: vasospasm and an increase in retinal arteriolar tone6 • Sclerotic phase: intimal thickening, hyperplasia of the tunica media, and hyaline degeneration in the subsequent sclerotic stage6 | • Risk of hypertension (odds ratio, 1.62; CI 95% 1.21 to 2.18)29–31 • Risk of stroke (relative risk, 1.24, CI 95% 0.66 to 2.31)34,35 • Risk of CHD in women (relative risk, 1.37; CI 95% 1.08 to 1.72)32 • Risk of diabetes mellitus (odds ratio, 1.71, CI 95% 1.13 to 2.57)33 • Relation to stiffness of the carotid arteries116 Risk of cognitive impairment:modest association3 | Clinical validation of the AVR Clinical significance (a) CVD evaluation in presence of retinal mcrovascular lesions (b) Potential value of specifically targeting the microcirculation in the treatment of hypertension Prevention (c) Role of retinal photography for CVD risk stratification | ||||
| Focal arteriolar narrowing | • Constricted area of two thirds or less the width of proximal and distal vessel segments17 | • Areas of localised vasoconstriction evaluated on the disc and within ½ DD of its margin zone17 | • Risk of any stroke (relative risk crude, 1.57, CI 95%, 1.0 to 2.45)34,35 • Risk of cognitive impairment:modest association36 | • Prevention Usefulness of focal arteriolar narrowing evaluation in the cerebrovascular risk stratification | ||||
| Arteriovenous nicking | • Present if seen in at least one of the temporal quadrants; definite if the venous blood column was tapered on both sides of its crossing under an arteriole; EDTRS standard photograph 917 | Sclerotic phase: intimal thickening, hyperplasia of the tunica media, and hyaline degeneration in the subsequent sclerotic stage6 | • Risk of any stroke (relative risk, 2.21, CI 95%, 1.44 to 3.38)34,35 • Risk of cognitive impairment:modest association36 | • Prevention Usefulness of arteriovenous nicking evaluation in the cerebrovascular risk stratification in hypertensives |