title: The long-term relation among retinal arteriolar narrowing, blood pressure, and incident severe hypertension.
abstract: The authors assessed associations between retinal vascular signs and incident severe hypertension in an older population-based cohort. At baseline (1992-1994), 3,654 residents aged 49-97 years living in the Blue Mountains area west of Sydney, Australia, were examined; respectively, 2,335 (75.1%) and 1,952 (76%) survivors were reexamined 5 and 10 years later. Retinal arteriolar and venular calibers were measured, and average central retinal artery and central retinal vein equivalents for that eye were estimated. Severe hypertension was defined by previous diagnosis of hypertension plus antihypertensive medication use or by systolic blood pressure > or =160 mmHg and/or diastolic blood pressure > or =100 mmHg at examinations. Of the 1,424 participants at risk, 618 developed severe hypertension over 10 years (cumulative incidence = 47.7%, 95% confidence interval: 44.9, 50.5). Participants who subsequently developed severe hypertension had significantly narrower mean central retinal artery equivalents than those who did not (187.0 vs. 191.9 mum, p < 0.0001). After adjusting for age, sex, body mass index, smoking, mean arterial blood pressure, and plasma glucose and triglyceride levels, baseline narrowing central retinal artery equivalent was associated with increased risk of severe hypertension (per standard deviation reduction, odds ratio = 1.1, 95% confidence interval: 1.1, 1.2; narrowest vs. widest quintile, odds ratio = 1.6, 95% confidence interval: 1.2, 2.1). These findings support structural narrowing in small arteries and arterioles antecedent to clinical onset of severe hypertension.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, Australia. jiejin_wang@wmi.usyd.edu.au
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Elena
authors.initials: E
authors.lastname: Rochtchina
authors.forename: Gerald
authors.initials: G
authors.lastname: Liew
authors.forename: Ava G
authors.initials: AG
authors.lastname: Tan
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Leeder
authors.forename: Wayne
authors.initials: W
authors.lastname: Smith
authors.forename: Anoop
authors.initials: A
authors.lastname: Shankar
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors