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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Objective: 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
Issue number1
Early online date8 Jan 2020
Publication statusPublished - Feb 2020


  • hypertension
  • imaging and diagnostics
  • microvascular disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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