Improving the description of the retinal vasculature and patient history taking for monitoring systemic hypertension

Abstract

Systemic hypertension is an important public health concern. If optometrists are to perform a more active role in the detection and monitoring of high blood pressure (BP), there is a need to improve the consistency of describing the retinal vasculature and to assess patient's ability to correctly report the diagnosis of hypertension, its control and medication. One hundred and one patients aged > 40 years were dilated and had fundus photography performed. BP was measured and a self-reported history of general health and current medication was compared with the records of their general practitioner (GP). The status of the retinal vasculature was quantified using a numeric scale by five clinicians and this was compared to the same evaluation performed with the aid of a basic pictorial grading scale. Image analysis was used to objectively measure the artery-to-vein (A/V) ratio and arterial reflex. Arteriolar tortuosity and calibre changes were found to be the most sensitive retinal signs of high BP. Using the grading scale to describe the retinal vasculature significantly improved inter- and intra-observer repeatability. Almost half the patients examined were on medication for high BP or cardiovascular disease. Patients' ability to give their complete medical history was poor, as was their ability to recall what medication they had been prescribed. GPs indicated it was useful to receive details of their patient's BP when it was > 140/90 mmHg. The use of improved description of the retinal vasculature and stronger links between optometrists and GPs may enhance future patient care.

Abnormalities of Retinal Microvascular Structure and Risk of Mortality From Ischemic Heart Disease and Stroke

“…However, tortuosity is difficult to assess by fundoscopy, and possible confounding factors, such as age, hypertension, or diabetes, were not accounted for in that study. Increased arterial tortuosity is associated with hypertension in both younger 23 and older patients, 24 although only a weak positive relationship between BP and tortuosity was observed in a large study of 715 subjects, 25 and retinal arteriolar tortuosity was not related to cerebral small vessel disease assessed by MRI. 26 We found a weak positive association between systolic BP and arteriolar tortuosity, and this cannot, therefore, account for the relationship of reduced tortuosity and IHD risk that we observed, so we conclude that the relationship between tortuosity and IHD death is independent of BP.…”

Blood pressure development and hypertensive retinopathy: 20-year follow-up of middle-aged normotensive and hypertensive men

“…The primary pathologic change in hypertensive retinopathy is therefore protective vasoconstriction, generalized arterial narrowing and arterial straightening. 5,6 International guidelines recommend examination of the optic fundus for initial evaluation of patients with hypertension, although with some variations. [7][8][9] The additional value of the information provided has been questioned, mainly because of the limitations caused by large interobserver variation.…”

The clinical assessment of retinal microvascular structure and therapeutic implications

“…Changes in vessel tortuosity are commonly considered to be an indicator of circulatory disease; however, tortuosity is difficult to assess by funduscopy and there have been few quantitative studies. Qualitatively, venular tortuosity is increased in diabetes [48], whereas increased arteriolar tortuosity has been reported in both younger [49] and older subjects [50] with hypertension. However, only a weak positive relationship between blood pressure and tortuosity was observed in another large study [51] and retinal arteriolar tortuosity was reported to be unrelated to cerebral small-vessel disease assessed by MRI [52].…”