August 12, 2013
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Retinal imaging could help predict likelihood of stroke

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Risk for stroke is elevated in people with hypertensive retinopathy, even if their BP is controlled. Retinal imaging could help detect those at risk, according to a new report.

Population-based study data suggest that “closely monitoring BPs and medication compliance may not be sufficient for stroke prevention in patients with hypertension,” Mohammad Kamran Ikram, MD, PhD, of the Singapore Eye Research Institute and National University of Singapore, and colleagues wrote. “Retinal assessment may be useful especially in those with good control of hypertension.”

Researchers investigated whether hypertensive retinopathy, as classified by a new, simpler system, can be a predictor of stroke for people with hypertension. They aimed to detect retinopathy with retinal photography instead of a clinical ophthalmoscopic examination, as previous research suggested the former has better reliability and reproducibility.

The analysis included 2,907 participants from the ARIC study who were aged 50 to 73 years at the 1993 to 1995 examination. The participants had prevalent hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥ 90 mm Hg, or use of antihypertensive medication within 2 weeks before the exam) and no history of stroke, CHD or diabetes at baseline. Participants with diabetes were excluded because hypertensive retinopathy can be difficult to distinguish from diabetic retinopathy. Each participant had gradable retinal photographs that were assessed for signs of hypertensive retinopathy (classification: none, mild, moderate/severe).

During a mean follow-up of 13 years, 165 participants experienced a stroke; 146 were cerebral infarctions and 15 were hemorrhagic strokes. After adjusting for age, sex, BP and other risk factors, the researchers determined that those with moderate hypertensive retinopathy were more likely to experience a stroke compared with those with no hypertensive retinopathy (multivariable HRs=2.37; 95% CI, 1.39-4.02).

The elevated risk for stroke was present even in participants whose BP was well controlled with medication (mild retinopathy: HR=1.96; 95% CI, 1.09-3.55; moderate retinopathy: HR=2.98; 95% CI, 1.01-8.83).

The association between hypertensive retinopathy and stroke risk suggests that “the presence of these retinal microvascular changes is indicative of additional vascular risk beyond that conferred by traditional CV risk factors,” Ikram and colleagues wrote. “Retinal photography is a potential clinical tool to indirectly assess potential microvascular damage in the cerebral vasculature.”

Disclosure: The researchers report no relevant financial disclosures.