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Journal of Hypertension:
doi: 10.1097/HJH.0b013e32836586f4
Reviews

Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data

Ding, Jiea,b; Wai, Khin Layc; McGeechan, Kevind; Ikram, M. Kamrana,b,e; Kawasaki, Ryof; Xie, Jingf; Klein, Ronaldg; Klein, Barbara B.K.g; Cotch, Mary Francesh; Wang, Jie Jinf,i; Mitchell, Pauli; Shaw, Jonathan E.j; Takamasa, Kayamak; Sharrett, A. Richeyl; Wong, Tien Y.a,b,e

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Abstract

Objective:

Microvascular dysfunction has been suggested to be a major pathogenic factor for the development of hypertension. We examined the association between retinal vascular caliber, a marker of systemic microvascular dysfunction, and incident hypertension on a meta-analysis of individual participant data.

Methods:

We performed a systematic review with relevant studies identified through a search of electronic databases, a review of reference lists, and correspondence with experts. Studies were included if participants were selected from a general population, retinal vascular caliber was measured from photographs using computer-assisted methods at baseline, and individuals were followed up to ascertain the incidence of hypertension. Prespecified individual recorded data from six population-based prospective cohort studies were included. Discrete time proportional odds models were constructed for each study with adjustment for hypertension risk factors. Log odds ratios (ORs) per 20-μm difference were pooled using random-effects meta-analysis.

Results:

Among 10 229 participants without prevalent hypertension, diabetes, or cardiovascular disease, 2599 developed new-onset hypertension during median follow-up periods ranging from 2.9 to 10 years. Both narrower retinal arterioles [pooled multivariate-adjusted OR per 20-μm difference 1.29, 95% confidence interval (CI) 1.20–1.39] and wider venules (OR per 20-μm difference 1.14, 95% CI 1.06–1.23) were associated with an increased risk of hypertension. Each 20 μm narrower arterioles at baseline were associated with a 1.12 mmHg (95% CI 0.25–1.99) greater increase in SBP over 5 years.

Conclusions:

Retinal arteriolar narrowing and venular widening were independently associated with an increased risk of hypertension. These findings underscore the importance of microvascular remodeling in the pathogenesis of hypertension.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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