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(Hypertension. 2006;47:e19.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Retinal Vessel Narrowing: A Prehypertensive or Masked Hypertensive State?

Nephrology and Hypertension Services, Hadassah–Hebrew University Medical Center, Jerusalem, Israel

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Based on analyses of Rotterdam Study data, Ikram et al¹ concluded that retinal vessel narrowing might precede the development of systemic hypertension. The authors have made a great effort to optimize the ophthalmoscopic technique and achieved a more sensitive method than those used previously. On the other hand, baseline blood pressure measurements were rather "old-fashioned," composed of 2 readings taken during a single visit. In an analogy to the authors’ conclusion that, compared with their methodology, "(standard ophthalmoscopy) may underestimate the extent of arteriolar narrowing and thereby the risk of hypertension," one may suggest that, in some subjects, blood pressure at baseline was underestimated by the standard clinic measurement. Thus, if in addition to the 2871 subjects excluded because of hypertension at screening, another 10% to 20%^2,3 (430 subjects) had masked hypertension at baseline, the true incidence of new hypertension (n=808) is probably overestimated. Therefore, a finding of retinal vessel narrowing in a subject with normal clinic blood pressure may indicate either a prehypertensive state (as the authors imply), or, not less likely, a masked hypertensive state. Ambulatory blood pressure monitoring may identify the true condition.⁴

1. Ikram MK, Witteman JC, Vingerling JR, Breteler MM, Hofman A, de Jong PT. Retinal vessel diameters and risk of hypertension: the Rotterdam Study. Hypertension. 2006; 47: 189–194.[Abstract/Free Full Text]

2. Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, Valagussa F, Bombelli M, Giannattasio C, Zanchetti A, Mancia G. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: Data from the general population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation. 2001; 104: 1385–1392.[Abstract/Free Full Text]

3. Ben-Dov IZ, Ben-Arie L, Mekler J, Bursztyn M. In clinical practice, masked hypertension is as common as isolated clinic hypertension: predominance of younger men. Am J Hypertens. 2005; 18: 589–593.[CrossRef][Medline] [Order article via Infotrieve]

4. Imai Y, Ohkubo T, Sakuma M, Tsuji I, Satoh H, Nagai K, Hisamichi S, Abe K. Predictive power of screening blood pressure, ambulatory blood pressure and blood pressure measured at home for overall and cardiovascular mortality: a prospective observation in a cohort from Ohasama, Northern Japan. Blood Press Monit. 1996; 1: 251–254.[Medline] [Order article via Infotrieve]

Response: Retinal Vessel Narrowing: A Prehypertensive or Masked Hypertensive State?

Department of Epidemiology and Biostatistics and, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands

Jacqueline C.M. Witteman

Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands

Johannes R. Vingerling

Department of Epidemiology and Biostatistics and, Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands

Monique M.B. Breteler; Albert Hofman

Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands

Paulus T.V.M. de Jong

Department of Epidemiology and Biostatistics and, Department of Ophthalmology, Erasmus Medical Center and, The Netherlands Institute for Neurosciences, Royal Netherlands Academy of Arts and Sciences, The Netherlands and, Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands

We read with interest the letter by Ben-Dov concerning the question of whether a finding of retinal vessel narrowing in a person with normal clinic blood pressure at baseline indicates either a prehypertensive or a masked hypertensive state. Prevalence of masked hypertension varies from 9% to 23%.¹ Within our large cohort, it was not feasible to have ambulatory baseline blood . . . [Full Text of this Article]