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Similarities and differences in early retinal phenotypes in hypertension and diabetes

Grosso, Andreaa; Cheung, Ningb; Veglio, Francoc; Wong, Tien Yinb,d

doi: 10.1097/HJH.0b013e3283496655

The use of retinal photography in clinical practice and research has substantially increased the knowledge about the epidemiology, natural history and significance of diabetic and hypertensive retinopathy. Early retinopathy signs, including retinal microaneurysms, blot hemorrhages, cotton-wool spots and hard exudates, are common vascular abnormalities found in middle-aged to older people with diabetes and hypertension. The presence of these early retinopathy signs is associated with an increased risk of systemic vascular diseases, such as stroke, cognitive impairment, coronary heart disease, heart failure and nephropathy. These retinopathy lesions may therefore be considered as biomarkers of systemic microvascular processes caused by diabetes and hypertension. Nevertheless, whereas the interest in retinopathy assessment continues to grow, a core concept remains undefined: what is the relative importance and contribution of diabetes and hypertension in the development of early retinopathy signs? The answer of this fundamental question holds the key to better understanding of the systemic associations of early hypertensive and diabetic retinopathy. In this review, we summarize the similarities and differences of early retinopathy signs seen in diabetes and hypertension, and discuss the conceptual relevance from epidemiological, pathophysiological, and clinical perspectives.

aCentre for Macular Research and Vitreo-retinal Diseases, Ophthalmic Private Practice, San, Italy

bCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia

cInternal Medicine Division and Hypertension Unit, Department of Internal Medicine and Experimental Oncology, Molinette Hospital, University of Torino, Italy

dSingapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore

Correspondence to Andrea Grosso, MD, Via Novara 8/b, 10099 San Mauro, Italy E-mail:

Abbreviations: ARIC, Atherosclerosis Risk in Communities Study; AusDiab, Australian Diabetes, Obesity and Lifestyle Study; DCCT, Diabetes Control and Complications trial; EDIC, Epidemiology of Diabetes Interventions and Complications Study Research Group; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; Pre-HPT, pre-hypertension; UKPDS, United Kingdom Prospective Diabetes Study; VEGF, vascular endothelial growth factor; WESDR, Wisconsin Epidemiological Study of Diabetic Retinopathy

Received 30 January, 2011

Revised 22 May, 2011

Accepted 1 June, 2011

© 2011 Lippincott Williams & Wilkins, Inc.