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Introduction
Hypertensive retinopathy is a condition characterised by a spectrum of retinal vascular findings in people with systemic arterial hypertension (hypertension). 1 Signs of hypertensive retinopathy range from retinal arteriolar narrowing and arteriovenous (AV) nicking to cotton-wool spots, hard exudates, retinal haemorrhages, and optic nerve oedema. The prevalence of hypertensive retinopathy in middle-aged to older patients ranges from 2% to 15% with dilated fundus photography and <1% with clinical ophthalmoscopy. 2-4
The detection of hypertensive retinopathy with direct ophthalmoscopy is considered the standard of care by the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 5 6 The JNC7 lists retinopathy as a marker of end-organ damage from systemic arterial hypertension (hypertension). 6 AV nicking is a clinical finding commonly agreed to be an indicator of underlying chronic hypertension. 5 Some patients, however, even those with marked, retinal arterial narrowing due to severe hypertension, do not demonstrate this finding. 5
As a corollary to the initial paper by Duker and Brown 7 describing the anterior location of a retinal artery over a retinal vein when retinal venous occlusion occurs at an AV junction, we hypothesised that AV nicking may also be more common when a retinal artery overlies a retinal vein. To our knowledge, relatively little attention has been devoted to this anatomic relationship between the vessels at sites of AV crossings in hypertensive patients. We consequently undertook a prospective evaluation of 134 eyes in consecutive patients with hypertension to determine the anatomical relationship of retinal arteries and veins at AV crossing sites.
Methods
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors EW, GB and MB were involved in data collection and analysis. All authors were involved in manuscript editing. Included in the study were consecutive patients with a history of pharmacologically treated hypertension and clear ocular media. In each instance, 45° high-resolution digital fundus photographs of consecutive patients seen on the Retina Service of Wills Eye Hospital were evaluated. Photographs of the posterior pole had to be of sufficient clarity to allow good visualisation of the temporal arcade vessels. Good visualisation was considered to be present when there was a clear view of the third-order retinal...