J Stroke Cerebrovasc Dis. 2026 Sep 27:108757. doi: 10.1016/j.jstrokecerebrovasdis.2026.108757. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: To determine whether hypertensive retinopathy (HTRP) is associated with progression of white matter hyperintensities (WMH) in a population-based cohort.
METHODS: In this prospective study, 241 prehypertensive and hypertensive older adults underwent baseline clinical evaluations, retinal fundus photography, and brain MRI between 2013-2015. Surviving participants were re-evaluated with MRI in 2025. HTRP was graded using the Keith-Wagener-Barker classification, and WMH severity was rated with the modified Fazekas scale. WMH progression was defined as an increase of ≥1 Fazekas grade. Clinical covariates were assessed according to the American Heart Association's Life's Simple 7 framework. Cox Proportional Hazards regression estimated the association of WMH progression with baseline HTRP grade, adjusting for demographics and cardiovascular risk factors. Sensitivity analyses explored the robustness of this association across alternative model specifications.
RESULTS: Of 241 participants, 124 (51%) completed follow-up imaging. Seventeen individuals (14%) had baseline HTRP Grade ≥2, and 51 (41%) showed WMH progression. Baseline HTRP Grade ≥2 was independently associated with higher risk of WMH progression after multivariable adjustment (HR: 4.28; 95% C.I.: 1.89 - 9.71). Participants lost to follow-up had a greater baseline vascular burden, suggesting that attrition likely biased results toward no effect. Sensitivity analyses yielded consistent results.
CONCLUSIONS: Baseline HTRP Grade ≥2 identifies individuals with a higher likelihood of WMH progression, supporting the concept that retinal microvascular abnormalities and WMH represent related manifestations of systemic microangiopathy. These findings highlight the potential of retinal imaging to stratify microvascular risk in settings where MRI-based monitoring is limited.
PMID:42801966 | DOI:10.1016/j.jstrokecerebrovasdis.2026.108757