title: The association of severity of retinal vascular changes and cardiac remodelling in systemic hypertension.
abstract: OBJECTIVE
  The aim of the study was to explore the association between hypertensive retinopathy, grades of retinopathy and cardiac remodelling.
  
  
  METHODS
  This was a cross-sectional observational study. A total of 500 consecutive hypertensive adults from the in-patient population were studied for the presence of hypertensive retinopathy by dilated fundoscopy. The presence of cardiac remodelling due to hypertension was studied both by electrocardiography (ECG) and echocardiography. Hypertensive target organ damage in other organs was also screened. In addition, the association of grades of hypertensive retinopathy with target organ damage was also analyzed.
  
  
  RESULTS
  Systolic blood pressure (BP) at presentation and duration of hypertension showed no relationship with markers of hypertensive heart disease. However, diastolic BP was significantly higher in patients with retinopathy. Hypertensive retinopathy was diagnosed in 324 subjects of whom 90 had grades 3 and 4 retinopathy. Patients with grades 3 and 4 retinopathy had significant associations with ECG evidence of left ventricular (LV) strain pattern and left atrial enlargement, and a weaker association with left ventricular hypertrophy (LVH) using QRS voltage criteria (Sokolov-Lyon). On echocardiography, grades 3 and 4 retinopathy were significantly associated with LVH, left atrial enlargement and reduced left ventricular ejection fraction (LVEF), as well as with higher creatinine values. A large number of these patients presented with heart failure. Cardiac remodelling was not seen in patients without retinopathy and was uncommon in patients with grades 1 and 2 retinopathy.
  
  
  CONCLUSIONS
  Grades 3 and 4 retinopathy demonstrated a significant association with LV strain pattern and left atrial enlargement on ECG, LVH and reduced LVEF on echocardiography as well as with heart failure. There was no relationship with systolic BP and duration of hypertension, while diastolic BP showed a significant positive correlation. Signs of hypertensive heart disease were practically absent in patients without hypertensive retinopathy and uncommon in those with grade 1-2 alterations.
authors.affiliation: Additional Professor and Head, Vitreo-Retinal Unit, Department of Ophthalmology, St. John's Medical College & Hospital, Bangalore, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Varghese
authors.affiliation: Associate Professor, Department of Cardiology, St.John's Medical College & Hospital, Bangalore, India srili2881967@yahoo.com.
authors.forename: Srilakshmi M
authors.initials: SM
authors.lastname: Adhyapak
authors.affiliation: Associate Professor, Division of Epidemiology and Biostatistics, St. John's Research Institute, Bangalore, India.
authors.forename: Tinku
authors.initials: T
authors.lastname: Thomas
authors.affiliation: Senior Resident, Department of Internal Medicine, Tufts University of Medicine, Boston, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Sunder
authors.affiliation: Professor and Head, Department of Cardiology, St.John's Medical College & Hospital, Bangalore, India.
authors.forename: Kiron
authors.initials: K
authors.lastname: Varghese
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012164:Retinal Diseases / Q000209:etiology*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: diabetes mellitus; hypertension; ischaemia; retinopathy; target organ damage