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

Kleins Lab // Publications // Feb 01 2014

PubMed ID: 24322199

Author(s): Ding J, Wai KL, McGeechan K, Ikram MK, Kawasaki R, Xie J, Klein R, Klein BB, Cotch MF, Wang JJ, Mitchell P, Shaw JE, Takamasa K, Sharrett AR, Wong TY; Meta-Eye Study Group. 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. Review. PMID 24322199

Journal: Journal Of Hypertension, Volume 32, Issue 2, Feb 2014

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.