Blood Pressure at Young Age Can Predict Ophthalmic Issues

New research from a team of investigators from the University of Basel in Switzerland is shedding new light on associations between retinal vessel diameters and blood pressure progression in children. 



Results of the study, which examined more than 250 children, found children with narrow retinal artery diameters were more likely to develop hypertension and those with higher blood pressure levels were more likely to develop retinal microvascular impairment during early childhood.

"Hypertension continues as the main risk factor for the development of cardiovascular diseases and mortality," said lead investigator Henner Hanssen, MD, the study's lead author and a professor in the department of sport, exercise and health at the University of Basel in Switzerland, in a statement. "Primary prevention strategies are needed to focus on screening retinal microvascular health and blood pressure in young children in order to identify those at increased risk of developing hypertension. The earlier we can provide treatment and implement lifestyle changes to reduce hypertension, the greater the benefit for these children."

With the prevalence of childhood hypertension rising, investigators sought to design a study to assess association between central retinal arteriolar (CRAE) and venular (CRVE) diameters with the development of hypertension in children. As such, investigators created their study to evaluate associations between baseline retinal vessel diameters with blood pressure evaluation of the next 4 years.

Using students between the ages of 6-8 years old from 26 schools across Switzerland in 2014, investigators identified 391 children to undergo baseline screening. For the purpose of the analysis, investigators only included the 262 children who underwent a follow-up visit during 2018.

At baseline, the 262 children included in the final analysis had a mean age of 7.4 years, a mean height of 126.0 cm, and a mean weight of 25.7 kg. In regard to blood pressure, mean systolic blood pressure was 104.4 mmHg with 76% in normal range while the mean diastolic blood pressure was 65.3 with 73.1% in normal range.

At follow-up, both systolic and diastolic ( mean changes: 3.965±8.25 and 1.733±7.63 mmHg, respectively) blood pressure rose significantly while CRAE decreased by a mean of -6.325±8.55 µm without significant changes in central retinal venular equivalent (-0.163±7.94 µm). Investigators noted children with narrower CRAE went on to develop higher systolic blood pressure at the 4-year follow-up (β [95% CI] 0.78 [0.170—1.398] mmHg per 10 µm decrease, P=.012). 



Of note, investigators observed children who had increased systolic or diastolic blood pressure at baseline went on to develop narrower CRAE at the 4-year follow-up. According to results, narrowing of retinal arterioles predicted evolution of a child’s systolic blood pressure. Additionally, increased systolic and diastolic blood pressure were associated with developing microvascular impairments.

"Early childhood assessments of retinal microvascular health and blood pressure monitoring can improve cardiovascular risk classification. Timely primary prevention strategies for children at risk of developing hypertension could potentially counteract its growing burden among both children and adults," Hanssen added, in the aforementioned statement.

Investigators noted multiple limitations within their study. Limitations included the inability to confirm blood pressure measurements over a single 24-hour period, puberty status of each child was not recorded, and inability to control for other confounders such as genetic factors or birth weight.

This study, “Retinal Vessel Diameters and Blood Pressure Progression in Children,” was published in Hypertension.