Epidemiological study of hypertensive retinopathy in the primary care setting: Retrospective cross-sectional review of retinal photographs

Objective:The objective is to estimate the prevalence and grading of hypertensive retinopa-thy in the primary care setting;examine the patient characteristics associated with hypertensive retinopathy;and examine the association of hypertensive retinopathy and other hypertension complications.Methods:This is a retrospective cross-sectional study.Subjects included adult hypertensive patients with available and gradable retinal photographs.Results:Two hundred fifty-six male hypertensive patients(34.3%)and 491 female hyper-tensive patients(65.7%)were included.The average duration of hypertension was 7.2 years,and 49.8%and 41.2%of patients were taking one or two antihypertensive medications respectively.Among 1491 qualified retinal photographs(744 right eye and 747 left eye),24.9%,62.6%,and 12.5%were classified as showing normal,mild,and moderate hypertensive retinopathy respec-tively.The three commonest retinal signs were generalized or focal arteriolar narrowing(650 cases,43.6%),hard exudates(168 cases,11.3%),and opacity(copper or silver wiring)of the arteriolar wall(166 cases,11.1%).Patients older than 61 years,having hypertension for more than 15 years,or taking three or more antihypertensive medications were significantly associated with hyperten-sive retinopathy(P<0.05).Conclusion:In a primary care clinic in Hong Kong,77.1%of hypertensive patients had hypertensive retinopathy.Advanced hypertensive retinopathy was the commonest target organ damage for hypertensive patients in a primary care clinic.

Hyperuricemia Accompanied with Changes in the Retinal Microcirculation in a Chinese High-risk Population for Diabetes

Objective To investigate the association of retinal vascular calibers with hyperuricemia in a middle‐aged and elderly population. Methods A cross‐sectional design was applied in this study and 869 participants aged ≥40 years from a high‐risk group for diabetes were recruited. All participants received the anthropometrical measurements and laboratory tests. Retinal arteriolar and venular caliber of the participants were measured with a semi‐automated system. Hyperuricemia was defined as a serum uric acid level 420 μmol/L in men and 360 μmol/L in women. Linear regression models were used to assess the association of hyperuricemia with retinal vascular calibers. These models were additionally adjusted for age, central obesity, hypertension, dyslipidemia, weekly activity, smoking status, and education. Results Among the 869 participants, 133 （15.3%） suffered from hyperuricemia. The crude mean serum uric acid level was 312.3 μmol/L （Standard Deviation 79.5）; mean concentration was 355.0 μmol/L （SD 75.5） in male participants, and 288.0 μmol/L （SD 71.1） in female participants （age‐adjusted difference 58.1 μmol/L, 95% Confidence Internal 48.5, 67.6）. After adjusting for additional covariates, male participants with hyperuricemia had 3.77 μm （95% CI ‐0.46, 8.00） smaller arteriolar caliber and 6.20 μm （95% CI 0.36, 12.04） larger venule than those without hyperuricemia; the corresponding numbers among female participants were 1.57 μm （95% CI ‐1.07, 4.21） for retinal arteriolar caliber and 2.28 μm （95% CI ‐1.72, 6.27） for retinal venular caliber. Conclusion Hyperuricemia was associated with smaller retinal arteriolar caliber and larger venular caliber mainly in male participants in this study.