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ARTICLE

Retinal Arteriolar Diameter and Risk for Hypertension

Tien Yin Wong, MD, PhD; Ronald Klein, MD, MPH; A. Richey Sharrett, MD, DrPH; Bruce B. Duncan, MD, PhD; David J. Couper, PhD; Barbara E.K. Klein, MD, MPH; Larry D. Hubbard, MAT; F. Javier Nieto, MD, PhD, for the Atherosclerosis Risk in Communities Study

17 February 2004 | Volume 140 Issue 4 | Pages 248-255

Background: Narrowing of the small arterioles has been hypothesized to contribute to the pathogenesis of hypertension, but prospective clinical data are lacking.

Objective: To examine the relation of retinal arteriolar narrowing to incident hypertension in healthy middle-aged persons.

Design: Prospective cohort study.

Setting: The population-based Atherosclerosis Risk in Communities Study, conducted in 4 U.S. communities.

Participants: 5628 persons 49 to 73 years of age without preexisting hypertension.

Measurements: Diameters of retinal vessels were measured from digitized retinal photographs. A summary arteriole-to-venule ratio was computed as an indicator of generalized arteriolar narrowing; a lower ratio indicated greater narrowing. Areas of focal arteriolar narrowing were defined from photographs by using a standard protocol. Incident hypertension, defined as systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or use of antihypertensive medication, was identified from the cohort.

Results: After 3 years of follow-up, 811 (14.4%) persons had developed hypertension. The incidence of hypertension was higher in persons with lower arteriole-to-venule ratios (incidence of 8.9%, 12.3%, 13.7%, 14.3%, and 22.3%, comparing decreasing quintiles of the ratio) and in persons with focal arteriolar narrowing than in those without focal arteriolar narrowing (25.1% vs. 13.0%). After the authors controlled for the average systolic and diastolic blood pressures over the preceding 6 years, body mass index, waist-to-hip ratio, and other risk factors, the odds of developing hypertension were approximately 60% higher in persons with lower arteriole-to-venule ratios (odds ratio, 1.62 [95% CI, 1.21 to 2.18] comparing lowest to highest quintile; P = 0.006 for trend) and focal arteriolar narrowing (odds ratio, 1.61 [CI, 1.27 to 2.04]; P < 0.001).

Conclusions: Smaller retinal arteriolar diameters are independently associated with incident hypertension, which suggests that arteriolar narrowing may be linked to the occurrence and development of hypertension.

Editors' Notes Context Does narrowing of small arterioles lead to or result from hypertension? Contribution This large prospective study measured diameters of small retinal vessels using digitized photographs in people without preexisting hypertension. After 3 years, more people with narrowed arterioles at baseline had hypertension than did people without any arteriolar narrowing. Implications Smaller arteriolar diameters are independently associated with development of hypertension. Cautions Rather than leading to hypertension, reduced arteriolar diameters at baseline might have reflected elevated blood pressure in persons who did not yet meet diagnostic criteria for hypertension. –The Editors

 

Author and Article Information

From University of Melbourne, Victoria, Australia; Singapore Eye Research Institute, National University of Singapore, Singapore; University of Wisconsin, Madison, Wisconsin; Johns Hopkins University, Baltimore, Maryland; Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; and University of North Carolina, Chapel Hill, North Carolina.

Acknowledgment: The authors thank the staff and participants in the ARIC study for their important contributions.

Grant Support: By National Heart, Lung, and Blood Institute contracts N01-HC-35125, N01-HC-35126, N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. Additional support was provided by National Institutes of Health grant EYO13939 (Drs. Wong and Klein) and a Centers of Excellence Grant of CNPq (the Brazilian National Research Council) (Dr. Duncan).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Tien Yin Wong, MD, PhD, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3002, Australia; e-mail, ophwty{at}nus.edu.sg.

Author Contributions: Conception and design: T.Y. Wong, R. Klein, B.E.K. Klein.

Analysis and interpretation of the data: T.Y. Wong, F.J. Nieto.

Drafting of the article: T.Y. Wong, F.J. Nieto.

Critical revision of the article for important intellectual content: T.Y. Wong, R. Klein, A.R. Sharrett, B.B. Duncan, D.J. Couper, B.E.K. Klein, L.D. Hubbard, F.J. Nieto.

Final approval of the article: T.Y. Wong, R. Klein, A.R. Sharrett, B.B. Duncan, D.J. Couper, B.E.K. Klein, L.D. Hubbard, F.J. Nieto.

Statistical expertise: B.B. Duncan, D.J. Couper.

Obtaining of funding: T.Y. Wong, R. Klein, B.E.K. Klein.

Administrative, technical, or logistic support: R. Klein, B.E.K. Klein, L.D. Hubbard, F.J. Nieto.

Collection and assembly of data: R. Klein, B.B. Duncan, D.J. Couper, B.E.K. Klein, L.D. Hubbard.

Current Author Addresses: Dr. Wong: Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3001, Australia.

Drs. R. Klein, B.E.K. Klein, and Hubbard: Department of Ophthalmology, University of Wisconsin, 610 North Walnut Street, Madison, WI 53726.

Dr. Sharrett: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.

Dr. Duncan: Social Medicine Department, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2600/414, Porto Alegre, RS 90035-003, Brazil.

Dr. Couper: Department of Biostatistics, University of North Carolina, 137 East Franklin Street, Chapel Hill, NC 27599.

Dr. Nieto: Department of Population Health Sciences, University of Wisconsin, 61l North Walnut Street, Madison, WI 53705.

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