Association between hypertension and retinal vascular features in ultra-widefield fundus imaging

Northern Ireland Cohort of Longitudinal Ageing

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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
Number of pages7
JournalOpen Heart
Issue number1
Publication statusPublished - 08 Jan 2020


  • Automation
  • Blood Pressure
  • Female
  • Fundus Oculi
  • Humans
  • Hypertension/complications
  • Image Interpretation, Computer-Assisted
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Ophthalmoscopy
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retinal Diseases/diagnostic imaging
  • Retinal Vessels/diagnostic imaging
  • Retrospective Studies


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