Validity of risk stratification of JSH 2025 guideline based on hypertensive retinal changes

We sought to assess the validity of risk stratification table of Japanese Society of Hypertension (JSH) 2025 guideline, based on Scheie hypertensive fundus changes. We analyzed the data of medical checkup of Saitama Red Cross Hospital from 2017 to 2024 who underwent fundus examination (N = 6953). Based on the risk stratification table of JSH 2025 guideline, age, sex, comorbidities, past history, and blood pressure (BP) at the health checkup examination were used to stratify the risk into 12 groups. As the original of this study, those with BP < 130/80 mmHg were further examined and a total of 15 groups were analyzed. Risk 1st category and BP < 130/80 mmHg were set as a control group. As the risk category and BP level each increased, the rate of Scheie hypertensive changes significantly increased. Samely, the rate of Scheie sclerotic changes also significantly increased. In the range of BP < 130/80 mmHg, the rate of fundus changes significantly increased as the risk category increased. In conclusion, the risk stratification table of JSH 2025 guideline was valid based on Scheie hypertensive changes in subjects with medical checkup. Furthermore, those with BP < 130/80 mmHg could be added in the risk stratification table.