ORIGINAL ARTICLE Target organ damage in hypertensive patients: correlation between retinal arteriovenular ratio and left ventricular geometric patterns R Meazza 1 , C Scardino 2 , L Grosso Di Palma 1 , GL Perrucci 2 , E Gallazzi 2 , M Cattaneo 2 , A Villarini 2 and F Magrini 1,2 Early evaluation of cardiovascular (CV) risk in hypertensive patients is of primary importance and studies of retinal vessels can be helpful. The aim of this study is to assess the correlation between retinal vessel changes and target organ damage (TOD), expressed as left ventricular remodelling (LVR) or hypertrophy (LVH). We evaluated 60 treated hypertensive individuals (mean age 60.9±13.3 years). On the basis of echocardiographic results, we divided the subjects showing the presence of TOD and subjects without TOD into Groups A and B, respectively. Both groups underwent a non-mydriatic digital retinography. The obtained vessel images were analysed using dedicated software in order to calculate AVR (arteriovenular ratio), index of the retinal arteriolar narrowing. The data analyses confirmed a mean AVR value of 0.86 in Group B and a mean value of 0.77 in Group A. AVR index was also analysed in a subgroup of A with evidence of LVR, and mean value was 0.76. The same procedure was carried out with subgroup of A with LVH and AVR index resulted 0.77. In all comparisons, P-value was statistically significant (Po0.05). Our findings provide evidence that in hypertensive patients retinal AVR correlates with the presence of TOD, in this study in the context of LVR and LVH. In conclusion, AVR offers a direct vision retinal microcirculation and, also, indirectly, provides information of the left ventricular geometric pattern in hypertensive patients; thus, AVR may have an important role in global CV risk stratification and could possibly be used for optimising the hypertensive patient management. Journal of Human Hypertension (2014) 28, 274–278; doi:10.1038/jhh.2013.69; published online 1 August 2013 Keywords: arteriovenular ratio; non-mydriatic digital retinography; target organ damage; left ventricular remodelling; left ventricular hypertrophy INTRODUCTION Current hypertension guidelines suggest that the preliminary evaluation of the hypertensive patient should focus on assessing cardiovascular (CV) risk, which is based not only on average blood pressure (BP) levels but also on the presence or absence of coexistent risk factors, clinical evidence of cardiovascular disease and target organ damage (TOD). 1 The Framingham Study assesses that abnormal left ventricular geometric patterns (remodelling and hypertrophy) are powerful predictors of increased morbidity and mortality in the general population as well as in hypertensive patients due to chronic increase in BP levels; 2–4 although left ventricular remodelling (LVR) or/and hypertrophy (LVH) is considered strong predictors of CV events, 5 the study of retinal changes as early markers of extracardiac TOD is still controversial. 6–9 It is well known that the retinal circulation undergoes many pathophysiological changes in response to elevated BP levels and previous studies have linked retinal abnormalities (arteriolar narrowing, arteriovenous nicking, wall opacification, micro- aneurysms and haemorrhages) with cardiovascular diseases. 10–13 However, these studies were largely criticised because of their limited reproducibility and imprecision of quantifying retinal vascular changes simply with a clinical ophthalmoscopic examination. 14,15 For this reason actually, the evaluation of retinal modifications was excluded from the list of validated TOD in the 2007 ESH/ESC Guidelines. 1 Over the years, according to the Atherosclerosis Risk in Communities study, the fundoscopic examination has gained novel popularity due to the availability of standardized procedures based on computer-assisted evaluation of digital non-mydriatic retinal photographs 16–18 and the measurement of retinal arterio- venular diameters (AVR index), a possible marker of subclinical vascular damage in hypertension. 19,20 The aim of the present study is to define AVR as a possible predictive marker of TOD in association with left ventricular abnormal geometric patterns in hypertensive patients. PATIENTS AND METHODS Study population A case–control study was drawn. Sixty consecutive well-treated hyperten- sive patients (35 men, 25 women, mean age 60.9 ± 13.3 years) referred to our Hypertension Centre were included in the study. The presence of well- controlled arterial hypertension was confirmed during the first visit at the outpatient clinic; all patients were treated with drugs acting on renin– angiotensin–aldosterone system and thiazide diuretics. Exclusion criteria were prior history or evidence of: heart failure, atrial fibrillation, myocardial infarction, stroke, valvular disease, secondary hypertension, coronary heart disease, diabetes mellitus, renal or liver insufficiency, chronic pulmonary disease, tumours and ophthalmologic disease. After an informed consent, all patients underwent the following proce- dures in the same day: 1. medical history investigation, physical examination, blood and urine sampling and anthropometric parameter measurement. 2. Clinic BP measurement and 24-h ambulatory BP monitoring, 21,22 which permits to better display the effectiveness of BP control therapy. The 24-h 1 Fondazione I.R.C.C.S. Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy and 2 Dipartimento di Scienze Cliniche e di Comunita `, Centro di Fisiologia Clinica dell’Ipertensione, Universita ` degli Studi di Milano, Milano, Italy. Correspondence: Dr R Meazza, Fondazione I.R.C.C.S. Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza, 35, Milano 20122, Italia. E-mail: roberto.meazza@policlinico.mi.it Received 15 January 2013; revised 14 June 2013; accepted 19 June 2013; published online 1 August 2013 Journal of Human Hypertension (2014) 28, 274–278 & 2014 Macmillan Publishers Limited All rights reserved 0950-9240/14 www.nature.com/jhh