Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Retinal microvasculature and masked hypertension in young adults: the African-PREDICT study

Hypertension Research volume 43, pages 1231–1238 (2020)Cite this article

Abstract

Masked hypertension is known to induce microvascular complications. However, it is unclear whether early microvascular changes are already occurring in young, otherwise healthy adults. We therefore investigated whether retinal microvascular calibers and acute responses to a flicker stimulus are related to masked hypertension. We used the baseline data of 889 participants aged 20–30 years who were taking part in the African Prospective study on the Early Detection and Identification of Cardiovascular Disease and Hypertension. Clinic and 24-h ambulatory blood pressure were measured. The central retinal artery equivalent (CRAE) and central retinal vein equivalent were calculated from fundus images, and retinal vessel dilation was determined in response to flicker light-induced provocation. A smaller CRAE was observed in those with masked hypertension vs. those with normotension (157.1 vs. 161.2 measuring units, P < 0.001). In forward multivariable-adjusted regression analysis, only CRAE was negatively related to masked hypertension [adjusted R2 = 0.267, β = −0.097 (95% CI = −0.165; −0.029), P = 0.005], but other retinal microvascular parameters were not associated with masked hypertension. In multivariable logistic regression analyses, masked hypertension [OR = 2.333, (95% CI = 1.316; 4.241), P = 0.004] was associated with a narrower CRAE. In young healthy adults, masked hypertension was associated with retinal arteriolar narrowing, thereby reflecting early microvascular alterations known to predict cardiovascular outcomes in later life.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization. 2009. https://apps.who.int/iris/handle/10665/44203.

  2. O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension Working Group on Blood Pressure Monitoring. Guidelines European Society of Hypertension Position Paper on Ambulatory Blood Pressure Monitoring. J Hypertens. 2013;31:1731.

    Article  Google Scholar 

  3. Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359–66.

    Article  CAS  Google Scholar 

  4. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  5. Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378:1509–20.

    Article  Google Scholar 

  6. Franklin SS, O’brien E, Staessen JA. Masked hypertension: understanding its complexity. Eur Heart J. 2017;38:1112–8.

    CAS  PubMed  Google Scholar 

  7. Hänninen M-RA, Niiranen TJ, Puukka PJ, Kesäniemi YA, Kähönen M, Jula AM. Target organ damage and masked hypertension in the general population: the Finn-Home study. J Hypertens. 2013;31:1136–43.

    Article  Google Scholar 

  8. Routledge FS, McFetridge-Durdle JA, Dean C. Night-time blood pressure patterns and target organ damage: a review. Can J Cardio. 2007;23:132–8.

    Article  Google Scholar 

  9. Moss HE. Retinal vascular changes are a marker for cerebral vascular diseases. Curr Neurol Neurosci Rep. 2015;15:40.

    Article  Google Scholar 

  10. Lim M, Sasongko MB, Ikram MK, Lamoureux E, Wang JJ, Wong TY, et al. Systemic associations of dynamic retinal vessel analysis: a review of current literature. Microcirculation. 2013;20:257–68.

    Article  Google Scholar 

  11. Al-Fiadh AH, Wong TY, Kawasaki R, Clark DJ, Patel SK, Freeman M, et al. Usefulness of retinal microvascular endothelial dysfunction as a predictor of coronary artery disease. Am J Cardiol. 2015;115:609–13.

    Article  Google Scholar 

  12. Nagel E, Vilser W, Lanzl I. Age, blood pressure, and vessel diameter as factors influencing the arterial retinal flicker response. Invest Ophthalmol Vis Sci. 2004;45:1486–92.

    Article  Google Scholar 

  13. Kotliar KE, Lanzl IM, Schmidt-Trucksäss A, Sitnikova D, Ali M, Blume K, et al. Dynamic retinal vessel response to flicker in obesity: a methodological approach. Microvasc Res. 2011;81:123–8.

    Article  Google Scholar 

  14. McGeechan K, Liew G, Macaskill P, Irwig L, Klein R, Klein BE, et al. Meta-analysis: retinal vessel caliber and risk for coronary heart disease. Ann Intern Med. 2009;151:404–13.

    Article  Google Scholar 

  15. Seidelmann SB, Claggett B, Bravo PE, Gupta A, Farhad H, Klein BE, et al. Retinal vessel calibers in predicting long-term cardiovascular outcomes: the atherosclerosis risk in communities study. Circulation. 2016;134:1328–38.

    Article  Google Scholar 

  16. Yatsuya H, Folsom AR, Wong TY, Klein R, Klein BE, Sharrett AR. Retinal microvascular abnormalities and risk of lacunar stroke: Atherosclerosis Risk in Communities Study. Stroke. 2010;41:1349–55.

    Article  Google Scholar 

  17. Triantafyllou A, Doumas M, Anyfanti P, Gkaliagkousi E, Zabulis X, Petidis K, et al. Divergent retinal vascular abnormalities in normotensive persons and patients with never-treated, masked, white coat hypertension. Am J Hypertens. 2013;26:318–25.

    Article  CAS  Google Scholar 

  18. Wei F-F, Zhang Z-Y, Thijs L, Yang W-Y, Jacobs L, Cauwenberghs N, et al. conventional and ambulatory blood pressure as predictors of retinal arteriolar narrowing. Hypertension. 2016;68:511–20.

    Article  CAS  Google Scholar 

  19. Schutte AE, Gona PN, Delles C, Uys AS, Burger A, Mels CM, et al. The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT): design, recruitment and initial examination. Eur J Preventive Cardiol. 2019;26:458–70.

  20. Mokwatsi GG, Schutte AE, Mels CMC, Kruger R. Morning blood pressure surge in young black and white adults: the African-PREDICT Study. J Hum Hypertens. 2019;33:22–33.

    Article  Google Scholar 

  21. Marfell-Jones MJ, Stewart A, De Ridder J. International standards for anthropometric assessment. International standards for anthropometric assessment. Wellington, New Zealand: International Society for the Advancement of Kinanthropometry. 2012.

  22. Kotliar K, Hauser C, Ortner M, Muggenthaler C, Diehl-Schmid J, Angermann S, et al. Altered neurovascular coupling as measured by optical imaging: a biomarker for Alzheimer’s disease. Sci Rep. 2017;7:12906.

    Article  Google Scholar 

  23. Malan L, Hamer M, Von Känel R, Schlaich MP, Reimann M, Frasure-Smith N, et al. Chronic depression symptoms and salivary NOx are associated with retinal vascular dysregulation: the SABPA study. Nitric Oxide. 2016;55:10–7.

    Article  Google Scholar 

  24. Liew G, Wong TY, Mitchell P, Wang JJ. Are narrower or wider retinal venules associated with incident hypertension? Hypertension. 2006;48:e10.

    Article  CAS  Google Scholar 

  25. Liew G, Sharrett AR, Kronmal R, Klein R, Wong TY, Mitchell P, et al. Measurement of retinal vascular caliber: issues and alternatives to using the arteriole to venule ratio. Invest Ophthalmol Vis Sci. 2007;48:52–7.

    Article  Google Scholar 

  26. Leung H, Wang JJ, Rochtchina E, Tan AG, Wong TY, Klein R, et al. Relationships between age, blood pressure, and retinal vessel diameters in an older population. Invest Ophthalmol Vis Sci. 2003;44:2900–4.

    Article  Google Scholar 

  27. Wong TY, Klein R, Klein BE, Meuer SM, Hubbard LD. Retinal vessel diameters and their associations with age and blood pressure. Invest Ophthalmol Vis Sci. 2003;44:4644–50.

    Article  Google Scholar 

  28. Hata J, Fukuhara M, Sakata S, Arima H, Hirakawa Y, Yonemoto K, et al. White-coat and masked hypertension are associated with albuminuria in a general population: the Hisayama Study. Hypertens Res. 2017;40:937.

    Article  CAS  Google Scholar 

  29. Nagel E, Vilser W, Fink A, Riemer T, Lanzl I. Blood pressure effects on retinal vessel diameter and flicker response: a 1.5-year follow-up. Eur J Ophthalmol. 2006;16:560–5.

    Article  CAS  Google Scholar 

  30. Mandecka A, Dawczynski J, Blum M, Müller N, Kloos C, Wolf G, et al. Influence of flickering light on the retinal vessels in diabetic patients. Diabetes Care. 2007;30:3048–52.

    Article  Google Scholar 

  31. Voets T, Nilius B. TRPCs, GPCRs and the Bayliss effect. EMBO J. 2009;28:4–5.

    Article  CAS  Google Scholar 

  32. Seifert B-U, Vilser W. Retinal Vessel Analyzer (RVA)-design and function. Biomed Tech. 2002;47:678–81.

    Article  Google Scholar 

  33. Seshadri S, Ekart A, Gherghel D. Ageing effect on flicker‐induced diameter changes in retinal microvessels of healthy individuals. Acta Ophthalmol. 2016;94:e35–42.

    Article  CAS  Google Scholar 

  34. Newman EA. Functional hyperemia and mechanisms of neurovascular coupling in the retinal vasculature. J Cereb Blood Flow Metab. 2013;33:1685–95.

    Article  CAS  Google Scholar 

  35. Noonan JE, Lamoureux EL, Sarossy M. Neuronal activity‐dependent regulation of retinal blood flow. Clin Exp Ophthalmol. 2015;43:673–82.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are indebted to all participants, students, and support and research staff. The financial support received from the DAAD/National Research Foundation, South Africa, is appreciated.

Funding

This research is part of an ongoing project financially supported by the South African Medical Research Council (SAMRC), with funds provided by the following: the National Treasury, under its Economic Competitiveness and Support Package; the South African Research Chairs Initiative (SARChI) of the Department of Science and Technology and National Research Foundation (NRF; UID86895 and 115354) of South Africa; the South African National Department of Health, GlaxoSmithKline R&D (Africa Non-Communicable Disease Open Lab grant); the UK Medical Research Council, with funds from the UK Government’s Newton Fund; corporate social investment grants from Pfizer (South Africa), Boehringer-Ingelheim (South Africa), Novartis (South Africa), the Mediclinic Hospital Group (South Africa); and in-kind contributions from Roche Diagnostics (South Africa). Any opinion, findings, conclusions, or recommendations expressed in this article are those of the authors, and the NRF does not accept any liability in regard thereto.

Author information

Authors and Affiliations

  1. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa

    Nthai E. Ramoshaba, Hugo W. Huisman, Leandi Lammertyn, Aletta E. Schutte & Wayne Smith

  2. South African Medical Research Council: Unit for Hypertension and Cardiovascular Diseases, North-West University, Potchefstroom, South Africa

    Hugo W. Huisman, Leandi Lammertyn, Aletta E. Schutte & Wayne Smith

  3. Department of Biomedical Engineering and Technomathematics, Aachen University of Applied Sciences, Juelich, North Rhine-Westphalia, Germany

    Konstantin E. Kotliar

  4. School of Public Health and Community Medicine, University of New South Wales; The George Institute for Global Health, Sydney, NSW, Australia

    Aletta E. Schutte

Authors
  1. Nthai E. Ramoshaba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hugo W. Huisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leandi Lammertyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantin E. Kotliar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aletta E. Schutte
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wayne Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wayne Smith.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramoshaba, N.E., Huisman, H.W., Lammertyn, L. et al. Retinal microvasculature and masked hypertension in young adults: the African-PREDICT study. Hypertens Res 43, 1231–1238 (2020). https://doi.org/10.1038/s41440-020-0487-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-020-0487-0

Keywords

This article is cited by

Search

Advanced search

Quick links