Retinal microvascular dysfunction mirrors subclinical neurovascular injury in chronic hypertension: A Cross-Sectional Study
Keywords:
aged, hypertension, magnetic resonance imaging, microcirculation, retina, retinal vessels, risk factors, vascular diseasesAbstract
Background: Retinal microvascular dysfunction may reflect early cerebral microvascular damage in chronic hypertension, but hospital-based evidence remains limited. Identifying noninvasive markers of subclinical neurovascular injury could support earlier risk stratification and improve assessment of hypertension-mediated target-organ involvement.
Aim: To examine the association between retinal microvascular dysfunction and subclinical neurovascular injury in adults with chronic hypertension
Approach: This cross-sectional study was conducted at Maasstad Hospital, the Netherlands, from February to April 2025. Adults with chronic hypertension were recruited by consecutive sampling. Of 231 screened individuals, 165 met inclusion criteria and had complete retinal imaging and brain MRI data. Linear regression and mediation analyses were performed using IBM SPSS Statistics version 27.
Results: The mean (SD) age was 61.8 (10.7) years, 55.8% were women, and median (IQR) hypertension duration was 9 (5-14) years. Worse retinal microvascular dysfunction was associated with higher subclinical neurovascular injury in the adjusted model (B, 0.31; 95% CI, 0.18 to 0.44; P < .001). Older age (B, 0.02; 95% CI, 0.01 to 0.03; P = .002) and longer hypertension duration (B, 0.03; 95% CI, 0.01 to 0.05; P = .009) also remained significant. The indirect association through retinal microvascular dysfunction was statistically significant
Conclusions: Retinal microvascular dysfunction was associated with greater subclinical neurovascular injury among adults with chronic hypertension in this hospital-based sample
Implication for Clinical Practice: These findings may inform earlier clinical risk identification, closer monitoring of older adults and patients with long-standing hypertension, and stronger interdisciplinary care coordination to support timely vascular assessment.
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