Stroke risk in patients with hypertensive retinopathy: a systematic review and meta-analysis

Hypertensive retinopathy (HTRP) is a complication of hypertension and is recognised as hypertension-mediated target-organ damage. Hypertension is also the leading risk factor for stroke. This systematic review and meta-analysis evaluated the stroke risk in patients with HTRP to determine whether HTRP is associated with stroke.

PubMed, Embase, Web of Science and the Cochrane Library were searched from inception to 13 December 2025. Pooled risk ratios with 95% CIs were calculated. For the proportions of HTRP and stroke among patients with hypertension, risk differences and standard errors were calculated. Subgroup analyses were conducted according to HTRP severity (mild and severe) and stroke type (ischaemic and haemorrhagic).

This meta-analysis included 10 studies involving 26 776 participants. The proportions of HTRP and stroke among all the participants were 0.42 (95% CI 0.23 to 0.61) and 0.15 (0.11 to 0.18), respectively. The proportion of stroke in participants with HTRP was 0.20 (0.14 to 0.27). The pooled risk ratio for stroke in patients with HTRP compared with those without HTRP was 1.87 (1.42 to 2.45). Compared with patients with mild HTRP and those without HTRP, patients with severe HTRP had higher risk of stroke, with risk ratios of 1.88 (1.51 to 2.34) and 3.10 (1.91 to 5.05), respectively. The risk ratios for ischaemic and haemorrhagic stroke in patients with HTRP compared with those without HTRP were 1.79 (1.20 to 2.67) and 1.39 (0.86 to 2.26), respectively.

HTRP is associated with an increased stroke risk, particularly ischaemic stroke. These findings suggest that HTRP can serve as an important biomarker for stroke-risk stratification, and that periodic retinal examinations can contribute to stroke prevention.