Evaluation of the Retinal Vasculature in Hypertension and Chronic Kidney Disease in an Elderly Population of Irish Nuns.
BACKGROUND
Chronic kidney disease (CKD) and hypertension are global public health problems associated with considerable morbidity, premature mortality and attendant healthcare costs. Previous studies have highlighted that non-invasive examination of the retinal microcirculation can detect microvascular pathology that is associated with systemic disorders of the circulatory system such as hypertension. We examined the associations between retinal vessel caliber (RVC) and fractal dimension (DF), with both hypertension and CKD in elderly Irish nuns.


METHODS
Data from 1233 participants in the cross-sectional observational Irish Nun Eye Study (INES) were assessed from digital photographs with a standardized protocol using computer-assisted software. Multivariate regression analyses were used to assess associations with hypertension and CKD, with adjustment for age, body mass index (BMI), refraction, fellow eye RVC, smoking, alcohol consumption, ischemic heart disease (IHD), cerebrovascular accident (CVA), diabetes and medication use.


RESULTS
In total, 1122 (91%) participants (mean age: 76.3 [range: 56-100] years) had gradable retinal images of sufficient quality for blood vessel assessment. Hypertension was significantly associated with a narrower central retinal arteriolar equivalent (CRAE) in a fully adjusted analysis (P = 0.002; effect size = -2.16 μm; 95% confidence intervals [CI]: -3.51, -0.81 μm). No significant associations between other retinal vascular parameters and hypertension or between any retinal vascular parameters and CKD were found.


CONCLUSIONS
Individuals with hypertension have significantly narrower retinal arterioles which may afford an earlier opportunity for tailored prevention and treatment options to optimize the structure and function of the microvasculature, providing additional clinical utility. No significant associations between retinal vascular parameters and CKD were detected.
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Amy
A
McGowan
Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland; Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland.
Giuliana
G
Silvestri
Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland.
Evelyn
E
Moore
Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland.
Vittorio
V
Silvestri
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Christopher C
CC
Patterson
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Alexander P
AP
Maxwell
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Gareth J
GJ
McKay
D000368:Aged; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000473:pathology*; D007494:Ireland; D008833:Microcirculation; D065831:Nuns; D051436:Renal Insufficiency, Chronic / Q000473:pathology*; D012160:Retina / Q000473:pathology; D012171:Retinal Vessels / Q000473:pathology*