Hypertensive retinopathy and risk of stroke

Yi Ting Ong, Tien Y. Wong, Ronald Klein, Barbara E.K. Klein, Paul Mitchell, A. Richey Sharrett, David J. Couper, M. Kamran Ikram

Research output: Contribution to journalArticlepeer-review


Although assessment of hypertensive retinopathy signs has been recommended for determining end-organ damage and stratifying vascular risk in persons with hypertension, its value remains unclear. In this study, we examine whether hypertensive retinopathy predicts the long-term risk of stroke in those with hypertension. A total of 2907 participants with hypertension aged 50 to 73 years at the 1993 to 1995 examination, who had gradable retinal photographs, no history of diabetes mellitus, stroke, and coronary heart disease at baseline and data on incident stroke, were included from the Atherosclerosis Risk in Communities (ARIC) Study. Retinal photographs were assessed for hypertensive retinopathy signs and classifed as none, mild, and moderate/severe. Incident events of any stroke, cerebral infarction, and hemorrhagic stroke were identifed and validated. After a mean follow-up period of 13.0 years, 165 persons developed incident stroke (146 cerebral infarctions and 15 hemorrhagic strokes). After adjusting for age, sex, blood pressure, and other risk factors, persons with moderate hypertensive retinopathy were more likely to have stroke (moderate versus no retinopathy: multivariable hazard ratios, 2.37 [95% confdence interval, 1.39-4.02]). In participants with hypertension on medication with good control of blood pressure, hypertensive retinopathy was related to an increased risk of cerebral infarction (mild retinopathy: hazard ratio, 1.96 [95% confdence interval, 1.09-3.55]; and moderate retinopathy: hazard ratio, 2.98 [95% confdence interval, 1.01-8.83]). Hypertensive retinopathy predicts the long-term risk of stroke, independent of blood pressure, even in treated patients with hypertension with good hypertension control. Retinal photographic assessment of hypertensive retinopathy signs may be useful for assessment of stroke risk.

Original languageEnglish (US)
Pages (from-to)706-711
Number of pages6
StatePublished - Aug 12 2013


  • Cerebral infarction
  • Hypertension
  • Hypertensive retinopathy
  • Stroke

ASJC Scopus subject areas

  • Internal Medicine

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