Associations between brachial‐ankle pulse wave velocity and hypertensive retinopathy in treated hypertensive adults: Results from the China Stroke Primary Prevention Trial (CSPPT)

Abstract

Abstract Although the association between persistent hypertension and the compromise of both micro‐ and macro‐circulatory functions is well recognized, a significant gap in quantitative investigations exploring the interplay between microvascular and macrovascular injuries still exists. In this study, the authors looked into the relationship between brachial‐ankle pulse wave velocity (baPWV) and hypertensive retinopathy in treated hypertensive adults. The authors conducted a cross‐sectional study of treated hypertensive patients with the last follow‐up data from the China Stoke Primary Prevention Trial (CSPPT) in 2013. With the use of PWV/ABI instruments, baPWV was automatically measured. The Keith‐Wagener‐Barker classification was used to determine the diagnosis of hypertensive retinopathy. The odds ratio (OR) and 95% confidence interval (CI) for the connection between baPWV and hypertensive retinopathy were determined using multivariable logistic regression models. The OR curves were created using a multivariable‐adjusted restricted cubic spline model to investigate any potential non‐linear dose‐response relationships between baPWV and hypertensive retinopathy. A total of 8514 (75.5%) of 11,279 participants were diagnosed with hypertensive retinopathy. The prevalence of hypertensive retinopathy increased from the bottom quartile of baPWV to the top quartile: quartile 1: 70.7%, quartile 2: 76.1%, quartile 3: 76.7%, quartile 4: 78.4%. After adjusting for potential confounders, baPWV was positively associated with hypertensive retinopathy (OR = 1.05, 95% CI, 1.03–1.07, p < .001). Compared to those in the lowest baPWV quartile, those in the highest baPWV quartile had an odds ratio for hypertensive retinopathy of 1.61 (OR = 1.61, 95% CI: 1.37–1.89, p < .001). Two‐piece‐wise logistic regression model demonstrated a nonlinear relationship between baPWV and hypertensive retinopathy with an inflection point of 17.1 m/s above which the effect was saturated .

Keywords

• fundus photograph
• hypertension
• hypertensive retinopathy
• Keith‐Wagener‐Barker classification
• pulse wave velocity