Hypertensive Retinopathy and Differential Cardiovascular Risk in Black and White Populations

Area of Science:

• Cardiology
• Ophthalmology
• Public Health

Background:

• Hypertensive retinopathy signifies systemic microvascular damage and predicts cardiovascular risk.
• Racial disparities in hypertension outcomes are known, but differential cardiovascular risk associated with hypertensive retinopathy across racial groups is understudied.

Purpose of the Study:

• To investigate whether hypertensive retinopathy confers differential cardiovascular risk in Black versus White populations.

Main Methods:

• Retrospective cohort study of 49,014 adults with hypertension and hypertensive retinopathy (2010-2021) from the TriNetX Research Network.
• Propensity score matching balanced 24,557 Black and 24,557 White patients across 34 baseline characteristics.
• Cox proportional hazard models assessed hazard ratios (HRs) and 95% confidence intervals (CIs) for major cardiovascular outcomes.

Main Results:

• Black patients with hypertensive retinopathy had higher rates of all-cause hospitalization (HR 1.076), acute heart failure (HR 1.125), myocardial infarction (HR 1.139), and ischemic stroke (HR 1.228).
• Atrial fibrillation/flutter was less common in Black patients (HR 0.848).

Conclusions:

• Black individuals with hypertensive retinopathy experienced worse cardiovascular outcomes than White individuals.
• Hypertensive retinopathy is a critical clinical risk marker, underscoring the need for equitable interventions to reduce racial disparities in hypertension complications.