Value of routine funduscopy in patients with hypertension: systematic review.
OBJECTIVE
To evaluate the additional value of funduscopy in the routine management of patients with hypertension.


METHODS
Systematic review.


METHODS
Adults aged 19 or more with hypertensive retinopathy.


METHODS
Medline, Embase, and the Cochrane Library from 1990.


METHODS
Studies were included that assessed hypertensive retinopathy with blinding for blood pressure and cardiovascular risk factors. Studies on observer agreement had to be assessed by two or more observers and expressed as a kappa statistic. Studies on the association between hypertensive retinopathy and hypertensive organ damage were carried out in patients with hypertension. The association between hypertensive retinopathy and cardiovascular risk was carried out in unselected normotensive and hypertensive people without diabetes mellitus.


RESULTS
The assessment of microvascular changes in the retina is limited by large variation between observers. The positive and negative predictive values for the association between hypertensive retinopathy and blood pressure were low (47% to 72% and 32% to 67%, respectively). Associations between retinal microvascular changes and cardiovascular risk were inconsistent, except for retinopathy and stroke. The increased risk of stroke, however, was also present in normotensive people with retinopathy. These studies did not adjust for other indicators of hypertensive organ damage.


CONCLUSIONS
Evidence is lacking that routine funduscopy is of additional value in the management of hypertensive patients.
Department of Internal Medicine, Academic Medical Centre, PO 22660, 1100 DD Amsterdam, Netherlands. b.j.vandenborn@amc.uva.nl
Bert-Jan H
BJ
van den Born
Caroline A A
CA
Hulsman
Joost B L
JB
Hoekstra
Reinier O
RO
Schlingemann
Gert A
GA
van Montfrans
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000473:pathology; D003955:Diagnostic Tests, Routine; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D015588:Observer Variation; D009887:Ophthalmoscopy / Q000592:standards* / Q000706:statistics & numerical data; D012164:Retinal Diseases / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D012171:Retinal Vessels / Q000473:pathology; D012307:Risk Factors