Article Text

Download PDFPDF

Original research
Association between hypertension and retinal vascular features in ultra-widefield fundus imaging
  1. Gavin Robertson1,
  2. Alan Fleming1,
  3. Michelle Claire Williams2,
  4. Emanuele Trucco3,
  5. Nicola Quinn4,
  6. Ruth Hogg4,
  7. Gareth J McKay4,
  8. Frank Kee4,
  9. Ian Young4,
  10. Enrico Pellegrini1,
  11. David E Newby2,
  12. Edwin J R van Beek2,5,
  13. Tunde Peto4,
  14. Baljean Dhillon6,
  15. Jano van Hemert1 and
  16. Thomas J MacGillivray5,6
  17. on behalf of Northern Ireland Cohort of Longitudinal Ageing
  1. 1 Research, Optos plc, Dunfermline, UK
  2. 2 Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Lothian, UK
  3. 3 The VAMPIRE Project, Computer Vision and Image Processing Group, School of Science and Engineering, University of Dundee, Dundee, Dundee, UK
  4. 4 Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
  5. 5 Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
  6. 6 The VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Gavin Robertson; grobertson{at}


Objective Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status.

Methods We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal–annular arteriole:venule ratio (NA-AVR), a novel combined parameter.

Results Left and right eyes were analysed from 440 participants (aged 50–59 years, mean age of 54.6±2.9 years, 247, 56.1% women), including 151 (34.3%) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95% CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95% CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020).

Conclusions Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.

  • hypertension
  • imaging and diagnostics
  • microvascular disease

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from


  • Collaborators The Northern Ireland Cohort of Longitudinal Ageing. IY-first Principal Investigator of NICOLA study. FK-Chair of the NICOLA Scientific Steering Committee

  • Contributors GR was the primary author and researcher for the manuscript. EP, AF and TM contributed to algorithm development. GR and NQ curated the dataset. AF, ET, GJMcK, JH and TM were supervisors and contributed to the review and accuracy of the manuscript. RH, FK and IY supervised the NICOLA study. All coauthors contributed to the interpretation of the results, drafted the manuscript and reviewed the final version.

  • Funding This study was funded by Scottish Image Network: A Platform for Scientific Excellence Knowledge Exchange Programme and Innovate UK Knowledge Transfer Partnership (1011973).

  • Competing interests GR, AF, EP and JvH: current employment at Optos plc. ET, NQ, RH, TP and TM: research grant. GJMcK: consultant.

  • Patient consent for publication Obtained.

  • Ethics approval Written informed consent, covering the use of data in future studies, was obtained from participants prior to taking part, and followed ethical approval from the School of Medicine, Dentistry and Biomedical Sciences Ethics Committee, Queen’s University Belfast (SREC 12/23).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data is available from the Northern Ireland Cohort for the Longitudinal Study of Aging (NICOLA); a long-term study of ageing in people aged 50 and over, with projected 10-year follow-up. We aim to encourage and facilitate data access with all ‘bona fide’ researchers and research organisations as defined by UK Research and Innovation (UKRI) ( and welcome proposals from researchers, either for collaborative projects or for other forms of data access in order to help advance research knowledge. For further information please see:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.