Association Between Blood Pressure Classification Using the 2017 ACC/AHA Blood Pressure Guideline and Retinal Atherosclerosis.

Journal Article (Journal Article)


We aimed to explore the association between the blood pressure (BP) classification defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the prevalence of retinal atherosclerosis.


This study was a retrospective observational cross-sectional analysis using the JMDC Claims Database. We analyzed 280,599 subjects not taking any antihypertensive medications. According to the 2017 ACC/AHA guideline, each subject was categorized as having normal BP (n = 159,524), elevated BP (n = 35,603), stage 1 hypertension (n = 54,795), or stage 2 hypertension (n = 30,677) using the BP value at the initial health checkup. Retinal photographs were assessed according to the Keith-Wagener-Barker system.


The median age was 46 years, and 50.4% subjects were men. Retinal atherosclerosis, defined as Keith-Wagener-Barker system grade ≥1, was observed in 3.2% in normal BP, 5.2% in elevated BP, 7.7% in stage 1 hypertension, and 18.7% in stage 2 hypertension. Compared with normal BP, elevated BP (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23-1.38), stage 1 hypertension (OR, 1.71; 95% CI, 1.64-1.79), and stage 2 hypertension (OR, 4.10; 95% CI, 3.93-4.28) were associated with a higher prevalence of retinal atherosclerosis. Among 92,121 subjects without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol consumption, elevated BP (OR, 1.34; 95% CI, 1.19-1.51), stage 1 hypertension (OR, 1.79; 95% CI, 1.61-1.98), and stage 2 hypertension (OR, 4.42; 95% CI, 4.00-4.92) were associated with a higher prevalence of retinal atherosclerosis. This association was observed in all subgroups stratified by age or sex.


Our investigation suggests that retinal atherosclerosis could start even in individuals with elevated BP and stage 1 hypertension.

Full Text

Duke Authors

Cited Authors

  • Matsuoka, S; Kaneko, H; Yano, Y; Itoh, H; Fukui, A; Morita, K; Kiriyama, H; Kamon, T; Fujiu, K; Seki, H; Michihata, N; Jo, T; Takeda, N; Morita, H; Nakamura, S; Yokoo, T; Nishiyama, A; Node, K; Yasunaga, H; Komuro, I

Published Date

  • October 2021

Published In

Volume / Issue

  • 34 / 10

Start / End Page

  • 1049 - 1056

PubMed ID

  • 34008020

Electronic International Standard Serial Number (EISSN)

  • 1941-7225

International Standard Serial Number (ISSN)

  • 0895-7061

Digital Object Identifier (DOI)

  • 10.1093/ajh/hpab074


  • eng