Value of routine funduscopy in patients with hypertension: systematic review

• Published in: BMJ Vol. 331; no. 7508; pp. 73 - 76
• Main Authors: van den Born, Bert-Jan H, Hulsman, Caroline A A, Hoekstra, Joost B L, Schlingemann, Reinier O, van Montfrans, Gert A
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 09.07.2005; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Adult; Aged; Agreements; Arterial hypertension. Arterial hypotension; Atherosclerosis; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Blood Pressure - physiology; Blood vessels; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Diseases - etiology; Cardiovascular Diseases - pathology; Classification; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Confidence intervals; Diabetes; Diabetic retinopathy; Diagnostic Tests, Routine; General aspects; Heart attacks; Hemorrhage; Humans; Hypertension; Hypertension - complications; Hypertension - pathology; Hypertension - physiopathology; Hypertensive retinopathy; Left ventricular hypertrophy; Medical diagnosis; Medical sciences; Microcirculation - physiology; Microscopy; Middle Aged; Mortality; Multivariate analysis; Observer Variation; Ophthalmoscopy; Ophthalmoscopy - standards; Ophthalmoscopy - utilization; Retina; Retinal Diseases - etiology; Retinal Diseases - pathology; Retinal Diseases - physiopathology; Retinal Vessels - pathology; Risk Factors; Statistics; Strokes; Studies; Human; Hypertension; Cardiovascular disease; Systematic review; Evidence-based medicine
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.331.7508.73

Objective To evaluate the additional value of funduscopy in the routine management of patients with hypertension. Design Systematic review. Participants Adults aged 19 or more with hypertensive retinopathy. Data sources Medline, Embase, and the Cochrane Library from 1990. Review methods Studies were included that assessed hypertensive retinopathy with blinding for blood pressure and cardiovascular risk factors. Studies on observer agreement had to be assessed by two or more observers and expressed as a κ statistic. Studies on the association between hypertensive retinopathy and hypertensive organ damage were carried out in patients with hypertension. The association between hypertensive retinopathy and cardiovascular risk was carried out in unselected normotensive and hypertensive people without diabetes mellitus. Results The assessment of microvascular changes in the retina is limited by large variation between observers. The positive and negative predictive values for the association between hypertensive retinopathy and blood pressure were low (47% to 72% and 32% to 67%, respectively). Associations between retinal microvascular changes and cardiovascular risk were inconsistent, except for retinopathy and stroke. The increased risk of stroke, however, was also present in normotensive people with retinopathy. These studies did not adjust for other indicators of hypertensive organ damage. Conclusion Evidence is lacking that routine funduscopy is of additional value in the management of hypertensive patients.