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Health & Medicine for Senior Citizens

A close look at your eyes may reveal your risk of a stroke

Retina shows status of blood vessels in the brain by non-invasive retinal imaging

Aug. 13, 2013 - In a study reported in the American Heart Association journal Hypertension, researchers said retinal imaging may someday help assess if you're more likely to develop a stroke the nation's No. 4 killer and a leading cause of disability.

"The retina provides information on the status of blood vessels in the brain," said Mohammad Kamran Ikram, M.D., Ph.D., lead author of the study and assistant professor in the Singapore Eye Research Institute, the Department of Ophthalmology and Memory Aging & Cognition Centre, at the National University of Singapore.

 "Retinal imaging is a non-invasive and cheap way of examining the blood vessels of the retina."


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Worldwide, high blood pressure is the single most important risk factor for stroke. However, it's still not possible to predict which high blood pressure patients are most likely to develop a stroke.

Researchers tracked stroke occurrence for an average 13 years in 2,907 patients with high blood pressure who had not previously experienced a stroke. At baseline, each had photographs taken of the retina, the light-sensitive layer of cells at the back of the eyeball. Damage to the retinal blood vessels attributed to hypertension called hypertensive retinopathy evident on the photographs was scored as none, mild or moderate/severe.

During the follow-up, 146 participants experienced a stroke caused by a blood clot and 15 by bleeding in the brain.

Researchers adjusted for several stroke risk factors such as age, sex, race, cholesterol levels, blood sugar, body mass index, smoking and blood pressure readings. They found the risk of stroke was 35 percent higher in those with mild hypertensive retinopathy and 137 percent higher in those with moderate or severe hypertensive retinopathy.

How does high blood pressure, also called hypertension, cause vision loss?

HBP can strain the vessels in the eyes and the optic nerve.
High blood pressure can place a strain on the blood vessels in the eyes. HBP can cause the blood vessels to either narrow or bleed when they are subjected to too much blood pressure force. Also, the optic nerve may swell, reducing the ability to see well.

Untreated HBP can cause permanent vision problems.
Using an opthalmoscope, a healthcare professional can look at the network of tiny capillaries on the retina to evaluate the condition of the blood vessels in the eyes. Managing blood pressure is the only way to treat hypertensive retinopathy. HBP damage is cumulative, so the longer it goes untreated, the higher the likelihood of permanent damage.

HBP can cause a stroke, which may lead to brain damage causing vision loss.
High blood pressure can lead to stroke, which, in turn, can impair the optic nerve or damage the area of the brain responsible for processing images.

Even in patients on medication and achieving good blood pressure control, the risk of a blood clot was 96 percent higher in those with mild hypertensive retinopathy and 198 percent higher in those with moderate or severe hypertensive retinopathy.

"It is too early to recommend changes in clinical practice," Ikram said. "Other studies need to confirm our findings and examine whether retinal imaging can be useful in providing additional information about stroke risk in people with high blood pressure."


Co-authors are Yi-Ting Ong, B.Sc.; Tien Y. Wong, M.D., Ph.D.; Ronald Klein, M.D., M.P.H.; Barbara Klein, M.D., M.P.H.; Paul Mitchell, M.D., Ph.D.; Richey Sharrett, Dr.P.H.; and David J. Couper, Ph.D. Author disclosures are on the manuscript.

The National Heart, Lung, and Blood Institute funded the study.

For the latest heart and stroke news, follow us on Twitter: @HeartNews.
For updates and new science in Hypertension, follow @HyperAHA.

American Heart Association Rapid Access Journal Report


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