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Incorporation of Retinal Arteriolosclerosis into Risk Stratification of Blood Pressure Category According to the 2017

Satoshi Matsuoka1,2, Hidehiro Kaneko1,3, Tatsuya Kamon1

  • 1The Department of Cardiovascular Medicine, The University of Tokyo.

Journal of Atherosclerosis and Thrombosis
|December 6, 2021
PubMed

Insights

Retinal arteriolosclerosis (RA) can improve cardiovascular disease (CVD) risk assessment in individuals classified by the 2017 ACC/AHA Blood Pressure (BP) guideline. Adding RA assessment enhances risk stratification, especially for stage 1 hypertension.

Area of Science:

  • Ophthalmology
  • Cardiology
  • Public Health

Background:

  • Cardiovascular disease (CVD) risk stratification relies on guidelines like the 2017 ACC/AHA Blood Pressure (BP) guideline.
  • Retinal arteriolosclerosis (RA) is a potential indicator of systemic vascular damage.
  • The utility of RA in refining CVD risk stratification within current BP guidelines is not fully established.

Purpose of the Study:

  • To investigate if retinal arteriolosclerosis (RA) can enhance cardiovascular disease (CVD) risk stratification.
  • To evaluate RA's role in individuals categorized by the 2017 ACC/AHA Blood Pressure (BP) guideline.
  • To determine if RA presence modifies CVD risk associated with different BP categories.

Main Methods:

  • A large cohort of 291,522 participants without prior CVD or BP medication use was analyzed.
  • Participants were categorized into six groups based on BP levels (normal/elevated, stage 1 hypertension, stage 2 hypertension) and presence or absence of RA (Keith-Wagener-Barker grade ≥ 1).
  • Multivariable Cox regression models assessed the association between BP categories, RA, and incident CVD events (MI, angina, stroke, HF) over a mean follow-up of 1,223 days.

Main Results:

  • The risk of CVD events increased with higher BP categories, and this risk was significantly amplified by the presence of RA.
  • Individuals with stage 1 hypertension and RA had a substantially higher hazard ratio for myocardial infarction (MI) compared to those with normal BP and no RA.
  • Similar associations between RA and increased CVD risk were observed for stroke and heart failure (HF).

Conclusions:

  • The presence of retinal arteriolosclerosis (RA) significantly modifies cardiovascular disease (CVD) risk stratification.
  • Incorporating RA assessment can improve the accuracy of risk prediction for individuals under the 2017 ACC/AHA BP guideline.
  • RA assessment is particularly valuable for refining risk in individuals classified with stage 1 hypertension.
Abstract

Keywords:
Cardiovascular diseaseHypertensionRetinal arteriolosclerosisRisk

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