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

J Hypertens. 2014 Feb;32(2):207-15. doi: 10.1097/HJH.0b013e32836586f4.

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.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Cohort Studies
  • Humans
  • Hypertension / etiology*
  • Hypertension / pathology
  • Hypertension / physiopathology
  • Microvessels / pathology
  • Microvessels / physiopathology
  • Prospective Studies
  • Retinal Vessels / pathology*
  • Retinal Vessels / physiopathology
  • Risk Factors

Grant support