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Retinal Vascular Occlusion Risks in High Blood Pressure and the Benefits of Blood Pressure Control
Hae Rang Kim1, Nang Kyeong Lee2, Christopher Seungkyu Lee3
1From the Department of Ophthalmology (H.R.K.), CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea.
Insights
Hypertension, including elevated blood pressure (BP) and stages 1 and 2, significantly increases the risk of retinal vascular occlusion. Controlling hypertension can lower this risk, but it remains higher than in individuals with normal BP.
Area of Science:
- Ophthalmology
- Cardiology
- Public Health
Background:
- Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases.
- Retinal vascular occlusion (RVO and RAO) can lead to vision impairment and is associated with systemic vascular health.
- Understanding the specific risks posed by different hypertension stages is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between different stages of hypertension and the risk of retinal vascular occlusion.
- To evaluate the impact of blood pressure control on the incidence of retinal vascular occlusion.
Main Methods:
- A nationwide, population-based retrospective cohort study design was employed.
- Participants were categorized into four blood pressure (BP) groups based on the 2017 ACC/AHA hypertension guidelines.
- Hazard ratios (HRs) for composite retinal vascular occlusion events were estimated across BP groups, considering BP changes over time.
Main Results:
- Elevated BP, stage 1, and stage 2 hypertension were all associated with significantly higher risks of retinal vascular occlusion compared to normal BP.
- Stage 2 hypertension showed a substantially higher risk (HR=1.32) than stage 1 (HR=1.07) or elevated BP (HR=1.10).
- Lowering BP significantly reduced the risk of retinal vascular occlusion in both stage 1 (HR=0.88) and stage 2 hypertension (HR=0.73).
Conclusions:
- Elevated blood pressure and diagnosed hypertension stages are linked to increased retinal vascular occlusion risk.
- While controlling hypertension reduces the risk, it remains elevated compared to individuals with normal BP.
- Retinal vascular occlusion risk is consistently higher once hypertension is diagnosed, underscoring the importance of BP management.
Purpose:
This study aimed to evaluate the association of retinal vascular occlusion, including retinal vein occlusion (RVO) and retinal artery occlusion (RAO), with stages of hypertension.
Design:
Nationwide, population-based retrospective cohort study.
Methods:
Based on baseline blood pressure (BP) as defined by the 2017 American College of Cardiology/American Heart Association guideline, participants were categorized into 4 BP groups. For the BP change measurement, BP groups were defined based on the combination of baseline and follow-up BP categories. The composite retinal vascular occlusion events and hazard ratios (HRs) of retinal vascular occlusion according to BP groups were estimated.
Results:
With normal BP as the reference, multivariate-adjusted HRs for retinal vascular occlusion were significantly higher than in other BP groups, showing much higher HRs in stage 2 hypertension than in stage 1 (HR, 1.10 for elevated BP; 1.07 for stage 1 hypertension; and 1.32 for stage 2 hypertension). Individual disease analysis showed consistent statistical significance in RVO, whereas RAO showed nonsignificant results. Lowering BP significantly decreased the HRs of retinal vascular occlusion in both stage 1 and stage 2 hypertension (HR, 0.88 and 0.73, respectively). However, once hypertension was diagnosed, the risk of retinal vascular occlusion was higher compared to that in the normal BP groups.
Conclusions:
Elevated BP, stage 1 hypertension, and stage 2 hypertension were all associated with higher retinal vascular occlusion risks than was normal BP. Controlling hypertension appears to reduce the risk of subsequent retinal vascular occlusion; however, the incidence rate was still be significantly higher than that in persons who maintained a normal BP.
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