Usefulness of optic fundus examination with retinography in initial evaluation of hypertensive patients.
BACKGROUND
Although international guidelines for management of hypertension recommend optic fundus examination in the initial evaluation of hypertensive patients, there have been no studies to evaluate the usefulness of retinography in this application.


METHODS
Two hundred and fifty consecutive new patients with hypertension but without known cardiovascular disease were studied. The average age was 57.2 years (s.d. 12.9) and 56% were men. The study was conducted in 14 primary care centers. Measurements included target organ damage (TOD) evaluation (electrocardiography, retinography, microalbuminuria, and serum creatinine) and blood pressure (BP) measurements. Outcome measurements were made to risk stratification according to 2003 World Health Organization and International Society of Hypertension (WHO-ISH) and 2007 European Society of Hypertension and European Society of Cardiology (ESH-ESC) guidelines, analyzed first without incorporating the retinography results and then reclassified using the retinography data.


RESULTS
Advanced retinopathy was detected in 10.8%. The risk stratification arrived at as per the WHO-ISH guidelines, and without the retinography data was: 11.4% low risk, 62.4% moderate risk, and 26.2% high risk. When retinography results were taken into account, 8% from the moderate-risk group were reclassified to the high-risk group (11.4, 54.4, and 34.2%, respectively; P < 0.001). Using ESH-ESC guidelines, the risk stratification without the retinography data was 0.9% reference, 11.3% low, 58.8% moderate, 21.7% high, and 7.3% very high risk. With retinography, 10% were reclassified from a lower to a higher risk group (0.9, 10.4, 51.1, 20.4, and 17.2%, respectively; P < 0.001).


CONCLUSIONS
As an alternative to optic fundus examination, retinography enables a more accurate cardiovascular risk stratification in the first evaluation after diagnosis of hypertension. When retinography is included in the assessment of cardiovascular risk, approximately 10% of patients are reclassified to a higher risk group.
Foguet
Quintí
Q
Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona and Hospital General de Vic, Vic, Spain. 42292qfb@comb.es
Rodríguez
Antonio
A
Saez
Marc
M
Ubieto
Antonio
A
Beltrán
Marta
M
Barceló
Maria A
MA
Coll
Gabriel
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D016001:Confidence Intervals; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012372:ROC Curve; D012160:Retina / Q000473:pathology*; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index