ADVANCED HYPERTENSIVE RETINOPATHY AND HYPERTENSION COMPLICATIONS IN THE PRIMARY CARE SETTING: RETROSPECTIVE CROSS-SECTIONAL STUDY

Introduction: International agencies had recognized hypertensive retinopathy (HTR) as target end organ damage. HTR can be reliably documented by retinal photographs. This study aims to examine the epidemiology of advanced HTR in the primary care setting; to assess patient predictive characteristics associated with advanced HTR; and to assess the association of advanced HTR with other HT complications. Methods: A retrospective cross-sectional review involving hypertensive patients with available and gradable retinal photographs. Patients with comorbidity of diabetes mellitus were excluded. All retinal photographs were reviewed by 2 family physicians independently according to Wong and Mitchell classification. Hypertension complications or end organ damages are documented according to ESH-ESC 2007 guideline. Results and Conclusion 256 (34.3%) male and 491 female (65.7%) hypertensive patients with mean (SD) age of 59.2 (8.6) years old were included. The average duration of hypertension was 7.2 years, while 49.8% and 41.2% were taking one and two antihypertensive medications respectively. The mean (SD) blood pressure was 128.2 (11.5)/75.3 (7.7) mmHg. Among 1491 retinal photographs, 24.9%, 62.6% and 12.5% were classified as normal, mild and moderate HTR. The commonest retinal signs was 650 (43.6%) generalized or focal arteriolar narrowing. 130 patients (17.4%) had advanced HTR, which was associated with advanced patient age, longer duration of hypertension, taking more antihypertensive agents. Multivariate analyses revealed that patient age was statistically significant associated with advanced HTR. The OR (95% CI) was 1.04 (1.02-1.06, P=0.001). Three leading hypertension complication or target organ damage were advanced HTR (17.4%), heart disease (7.1%) and cerebrovascular disease (3.9%).