Retinal imaging to identify target organ damage in older Africans: A pilot study

Rebecca Jones MBBS1 | Harry W.I. Putnam MBBS1 | Heiko Philippin MD2,3 | Charles Cleland MBBS4 | David H. Steel MBBS5,6 | William K. Gray PhD7 | Joanna E. Klaptocz MBBS7 | Bernadetha Swai MD8 | Richard W. Walker MD7,9 1 The Medical School, Newcastle University, Newcastle upon Tyne, UK 2 Kilimanjaro Christian Medical Centre, Moshi, Tanzania 3 International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London, UK 4 Faculty of Medicine, Imperial College London, London, UK 5 Sunderland Eye Infirmary, Sunderland, UK 6 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK 7 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK 8 Hai District Medical Centre, Boman'gombe, Kilimanjaro, Tanzania 9 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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By 2030, sub‐Saharan Africa is forecast to see the steepest rise in the number of people with hypertension of any world region. Hypertensive retinopathy is known to be a common complication of hypertension in developed countries and some studies suggest it is associated with the presence of other hypertension‐related end‐organ damage (EOD) such as stroke and cardiovascular disease. In Tanzania hypertension is relatively more common than in other parts of sub‐Saharan Africa, especially in the older population; however, the prevalence of hypertensive retinopathy and its asso‐ ciation with EOD remain unknown. The authors conducted a cross‐sectional study of elderly, community‐dwelling, rural Tanzanians to determine the prevalence of hyper‐ tensive retinopathy and its association with hypertension and other forms of EOD. Hypertensive retinopathy was diagnosed based on retinal imaging. In a cohort of 61 patients with gradable images, the authors found the overall prevalence of hyperten‐ sive retinopathy to be 64% (n = 39), which was strongly associated with hypertension (X2 [1] = 4.207, P = .004), with a significant trend towards more severe retinopathy with more severe hypertension (r = .377, P = .003). The authors did not find hyper‐ tensive retinopathy to be associated with other forms of EOD. Hypertensive retin‐ opathy is highly prevalent in this population and is associated in most but not all cases with hypertension. These findings do not suggest that it could be used as a screening tool for EOD, but it is important to identify and educate patients with retinopathy about possible complications of the condition.