Edinburgh Imaging

10 Jan 20. Featured Paper

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

Link to paper on BMJ journals



Gavin Robertson, Alan Fleming, Michelle Claire Williams, Emanuele Trucco, Nicola Quinn, Ruth 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



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 & 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 & 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 & 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 & right eyes, highlighting the importance of investigating both eyes of a patient.