title: Direct ophthalmoscopy versus detection of hypertensive retinopathy: a comparative study.
abstract: BACKGROUND
  Detection of hypertensive retinopathy (HR) with direct ophthalmoscopy is part of the assessment of hypertensive patients. Its use has been questioned because of its subjectivity and high interobserver variability.
  
  
  OBJECTIVE
  To determine the prevalence of HR in hypertensive patients under outpatient monitoring, the correlation between diagnosis and ophthalmoscopy and angiography, and to correlate it with other target organ damages.
  
  
  METHODS
  An observational, analytical and cross-sectional evaluation of 99 patients. Direct ophthalmoscopy and angiography performed by two investigators independently. Classification of RH, as described by Keith, Wagener and Barker.
  
  
  RESULTS
  The prevalence of HR of any grade was higher than 90.0% by both methods. On ophthalmoscopy, we observed grade I abnormalities in 51.0%, grade II in 43.0%, with one patient with grade III HR. On angiography, we observed grade I abnormalities in 42.0% and grade II in 52.0%. We detected three patients with grade III HR, two of which were not detected by ophthalmoscopy. Observers' agreement for the presence and severity of HR was poor with direct ophthalmoscopy and good with angiography. Renal dysfunction, ECG abnormalities (ventricular hypertrophy, pathological Q wave, repolarization abnormalities), and history of stroke were observed in 70.0%, 27.0% and 10.0% of patients, respectively. There was no relationship between the severity of HR and other target organ damages.
  
  
  CONCLUSIONS
  We observed a high prevalence of HR using both methods. Observers' agreement for the diagnosis and determination of the severity of HR was better with angiography. In our sample, there was no association of the severity of HR with other target organ damages.
authors.affiliation: Universidade Federal do Maranhão, São Luiz, MA, Brasil. jafneto@cardiol.br
authors.forename: José Albuquerque de
authors.initials: JA
authors.lastname: Figueiredo Neto
authors.forename: Guilherme Lima
authors.initials: GL
authors.lastname: Palácio
authors.forename: Allison Nobrega Dos
authors.initials: AN
authors.lastname: Santos
authors.forename: Pamela Suelen Serra
authors.initials: PS
authors.lastname: Chaves
authors.forename: Germana Viana
authors.initials: GV
authors.lastname: Gomes
authors.forename: Tassiane Soares
authors.initials: TS
authors.lastname: Cabral
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D058437:Hypertensive Retinopathy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D015588:Observer Variation; D009887:Ophthalmoscopy / Q000379:methods*; D015995:Prevalence; D011859:Radiography; D012720:Severity of Illness Index