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Prospective cohort study of retinal vessel diameters and risk of hypertension

BMJ 2004; 329 doi: (Published 08 July 2004) Cite this as: BMJ 2004;329:79
  1. Tien Yin Wong, associate professor1 (twong{at},
  2. Anoop Shankar, research associate2,
  3. Ronald Klein, professor2,
  4. Barbara E K Klein, professor2,
  5. Larry D Hubbard, associate director3
  1. 1 Centre for Eye Research Australia, University of Melbourne, Victoria 3002, Australia
  2. 2 Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin 53726, USA
  3. 3 Fundus Photograph Reading Centre, University of Wisconsin, Madison
  1. Correspondence to: T Wong
  • Accepted 29 April 2004


Objective To examine the relation between diameters of the retinal arterioles and 10 year incidence of hypertension.

Design Population based prospective cohort study.

Setting Beaver Dam eye study.

Participants 2451 normotensive people aged 43 to 84 years.

Main outcome measures Diameters of retinal arterioles and venules measured from digitised photographs of the retina taken at baseline. Measurements summarised as the arteriole:venule ratio, with a lower ratio indicating smaller arteriolar diameters. Incident hypertension, defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive drugs during follow up.

Results 721 participants developed hypertension over a 10 year period. Those with lower arteriole:venule ratio had a higher cumulative incidence of hypertension (incidences of 17.4%, 24.1%, 31.0%, and 45.1%, respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ratios in the lowest quarter had a threefold higher risk of hypertension (odds ratio 2.95, 95% confidence interval 2.77 to 3.88) than those with ratios in the highest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82, 1.39 to 2.40, for lowest versus highest ratio quarters).

Conclusions Narrowed retinal arterioles are associated with long term risk of hypertension, suggesting that structural alterations of the microvasculature may be linked to the development of hypertension.


  • Contributors TYW formulated the hypothesis and wrote the initial and final drafts. AS performed the statistical analysis and provided additional intellectual input. RK and BEKK reviewed the manuscript and provided overall supervision and administrative support for the project. LDH designed the method of measuring retinal vessel diameters and critically reviewed the paper. TYW is guarantor.

  • Funding American Diabetes Association (RK, AS), NIH grants EYO6594 (RK, BEKK) and HL66018 (RK, TYW), and the Singapore Biomedical Research Council Young Investigator Award (TYW).

  • Competing interests None declared.

  • Ethical approval All data were collected with Institutional Review Board approval in conformity with all country, federal, and state laws.

  • Accepted 29 April 2004
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