Association between Hypertension and Retinal Vascular Features in Ultra-Widefield Fundus Imaging

, Gavin Robertson (Lead / Corresponding author), Alan Fleming, Michelle C. Williams, Manuel Trucco, Nicola B. Quinn, Ruth E. Hogg, Gareth J. McKay, Frank Kee, Ian Young, Enrico Pellegrini, David E. Newby, Edwin J. R. van Beek, Tunde Peto, Baljean Dhillon, Jano van Hemert, Thomas J. MacGillivray

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Abstract

Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status. Methods We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal-annular arteriole:venule ratio (NA-AVR), a novel combined parameter. Results Left and right eyes were analysed from 440 participants (aged 50-59 years, mean age of 54.6±2.9 years, 247, 56.1% women), including 151 (34.3%) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95% CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95% CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020). Conclusions Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.

Original languageEnglish
Article numbere001124
Pages (from-to)1-7
Number of pages7
JournalOpen Heart
Volume7
Issue number1
Early online date8 Jan 2020
DOIs
Publication statusPublished - Feb 2020

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Retinal Vessels
Arterioles
Hypertension
Venules
Nose
Blood Pressure
ROC Curve
Blood Vessels
Retina
Health
Population

Keywords

  • hypertension
  • imaging and diagnostics
  • microvascular disease

Cite this

, Robertson, G., Fleming, A., Williams, M. C., Trucco, M., Quinn, N. B., ... MacGillivray, T. J. (2020). Association between Hypertension and Retinal Vascular Features in Ultra-Widefield Fundus Imaging. Open Heart, 7(1), 1-7. [e001124]. https://doi.org/10.1136/openhrt-2019-001124
Robertson, Gavin ; Fleming, Alan ; Williams, Michelle C. ; Trucco, Manuel ; Quinn, Nicola B. ; Hogg, Ruth E. ; McKay, Gareth J. ; Kee, Frank ; Young, Ian ; Pellegrini, Enrico ; Newby, David E. ; van Beek, Edwin J. R. ; Peto, Tunde ; Dhillon, Baljean ; van Hemert, Jano ; MacGillivray, Thomas J. / Association between Hypertension and Retinal Vascular Features in Ultra-Widefield Fundus Imaging. In: Open Heart. 2020 ; Vol. 7, No. 1. pp. 1-7.
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abstract = "Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status. Methods We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal-annular arteriole:venule ratio (NA-AVR), a novel combined parameter. Results Left and right eyes were analysed from 440 participants (aged 50-59 years, mean age of 54.6±2.9 years, 247, 56.1{\%} women), including 151 (34.3{\%}) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95{\%} CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95{\%} CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020). Conclusions Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.",
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Robertson, G, Fleming, A, Williams, MC, Trucco, M, Quinn, NB, Hogg, RE, McKay, GJ, Kee, F, Young, I, Pellegrini, E, Newby, DE, van Beek, EJR, Peto, T, Dhillon, B & van Hemert, J & MacGillivray, TJ 2020, 'Association between Hypertension and Retinal Vascular Features in Ultra-Widefield Fundus Imaging', Open Heart, vol. 7, no. 1, e001124, pp. 1-7. https://doi.org/10.1136/openhrt-2019-001124

Association between Hypertension and Retinal Vascular Features in Ultra-Widefield Fundus Imaging. /; Robertson, Gavin (Lead / Corresponding author); Fleming, Alan; Williams, Michelle C.; Trucco, Manuel; Quinn, Nicola B.; Hogg, Ruth E.; McKay, Gareth J.; Kee, Frank; Young, Ian; Pellegrini, Enrico; Newby, David E.; van Beek, Edwin J. R.; Peto, Tunde; Dhillon, Baljean; van Hemert, Jano; MacGillivray, Thomas J.

In: Open Heart, Vol. 7, No. 1, e001124, 02.2020, p. 1-7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association between Hypertension and Retinal Vascular Features in Ultra-Widefield Fundus Imaging

AU - Robertson, Gavin

AU - Fleming, Alan

AU - Williams, Michelle C.

AU - Trucco, Manuel

AU - Quinn, Nicola B.

AU - Hogg, Ruth E.

AU - McKay, Gareth J.

AU - Kee, Frank

AU - Young, Ian

AU - Pellegrini, Enrico

AU - Newby, David E.

AU - van Beek, Edwin J. R.

AU - Peto, Tunde

AU - Dhillon, Baljean

AU - van Hemert, Jano

AU - MacGillivray, Thomas J.

N1 - SINAPSE (Scottish Image Network: A Platform for Scientific Excellence) Knowledge Exchange Programme Innovate UK Knowledge Transfer Partnership (1011973)

PY - 2020/2

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N2 - Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status. Methods We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal-annular arteriole:venule ratio (NA-AVR), a novel combined parameter. Results Left and right eyes were analysed from 440 participants (aged 50-59 years, mean age of 54.6±2.9 years, 247, 56.1% women), including 151 (34.3%) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95% CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95% CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020). Conclusions Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.

AB - Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status. Methods We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal-annular arteriole:venule ratio (NA-AVR), a novel combined parameter. Results Left and right eyes were analysed from 440 participants (aged 50-59 years, mean age of 54.6±2.9 years, 247, 56.1% women), including 151 (34.3%) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95% CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95% CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020). Conclusions Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.

KW - hypertension

KW - imaging and diagnostics

KW - microvascular disease

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U2 - 10.1136/openhrt-2019-001124

DO - 10.1136/openhrt-2019-001124

M3 - Article

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SP - 1

EP - 7

JO - Open Heart

JF - Open Heart

SN - 2053-3624

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