Retinopathy as an indicator of silent brain infarction in asymptomatic hypertensive subjects

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Abstract

Background and purpose

Silent brain infarction (SBI), which is cerebral target organ damage of hypertensive microangiopathies, is frequently seen in hypertensive patients. The purpose of this study is to investigate the relation between hypertensive retinopathy (HTR) and SBI in subjects without a history of stroke or transient ischemic attack.

Methods

Five hundred-fifty hypertensive subjects without history of stroke or transient ischemic attack had brain MRI and retinal photographs taken. The presence of SBI was assessed from the MRI scans, which was defined as a lesion of at least 3 mm in diameter with typical imaging characteristics. The presence HTR was defined from digitized retinal photographs.

Results

Seventy-seven subjects (14%) showed HTR (grade 1 in 46, grade 2 in 31 persons). A multivariate analysis showed that age (OR, 1.07; 95% CI, 1.03 to 1.10) and HTR (OR, 2.01 for grade 1; OR, 3.03 for grade 2) were the independent indicators for the presence of SBI. The higher the grade of HTR, the more prevalent SBI than persons with normal retina (by linear by linear association test, p = 0.001).

Conclusion

HTR is associated with the presence of SBI. This finding suggests that retinal photography may be useful for identifying hypertensive subjects at increased risk of having SBI regardless of current blood pressure status.

Introduction

Silent brain infarction (SBI) is frequently seen in older hypertensive patients, especially when moderate hypertensive changes are found in major target organs [1]. Hypertension is the most well-known major risk factor for SBI [2], [3], [4], [5]. The presence of an SBI can predict clinical overt stroke [1], [3] or reduced cognitive functioning [5], [6]. Therefore, hypertension and progression of its target organ damage are strongly correlated with the appearance of SBI.

Funduscopy is recommended as part of the routine examination of hypertensive people. Retinal microvascular abnormalities have been suggested as signs of cerebral microvascular diseases, because the retinal arteries share common anatomic, embryologic, and physiologic characteristics with the cerebral microcirculation [7], [8]. Some signs of retinopathy were related with a risk of newly diagnosed clinical stroke [9], reduced cognitive performance [10], cerebral white matter lesions [11], and cerebral atrophy [12].

However, few clinical data are available to support the claim that hypertensive retinopathy (HTR) is associated with the presence of SBI. The purpose of this study is to investigate the relationship between SBI and HTR in hypertensive subjects.

Section snippets

Subjects

We studied 550 asymptomatic hypertensive subjects who visited Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea, from October 2003 through December 2004 and who underwent brain MRI and retinal photographs as part of their voluntary health check. Our participants were recruited from among subjects who visited our hospital to check their general health status. Subjects' ages ranged from 25 to 83. Their mean age was 59.3. Clinical information was

Results

Seventy-seven (14%) of the 550 individuals were found to have HTR. Of the 77 subjects with HTR, 60 had grade 1 HTR and 17 had grade 2 HTR. Sixty-one subjects (11.1%) had one or more SBI. A total of 96 SBI lesions were detected. The mean number of SBI was 1.6 (maximum SBI was 8). Also, 68% of SBI were located in the basal ganglia and thalamus, and 29% were in the subcortical white matter. No patients had cortical SBI in this study group.

Table 1 shows the prevalence of HTR among subjects with and

Discussion

The purpose of the present study was to investigate the relation between SBI and HTR. Subjects with HTR had about 2 to 3-fold greater risk of SBI than those without HTR. Hypertension is the most well-known major risk factor for stroke and is closely related to the appearance of SBI [2], [3], [4], [5]. To determine the clinical significance of hypertension in the appearance of SBI, we tried to clarify the relation between hypertensive target organ damage such as HTR and SBI. This result shows

Acknowledgments

This research was supported by grants of the Korea Health 21 R&D Project, Ministry of Health and Welfare (A060171 and A060263).

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