Objective: Hypertensive retinopathy is a marker of systemic microvascular damage and increased cardiovascular risk. Ambulatory blood pressure monitoring (ABPM) provides a comprehensive assessment of blood pressure burden, but the relative contribution of different ABPM periods to hypertensive retinopathy remains incompletely characterized. Design and method: We conducted a cross-sectional analysis using data from a tertiary cardiology center. Individuals with valid hypertensive retinopathy grading according to the Keith–Wagener–Barker classification (grades 0–3) and complete ambulatory blood pressure monitoring (ABPM) data were included. The primary outcome was moderate-to-severe hypertensive retinopathy (grades 2–3). Exposures of interest were ambulatory systolic (SBP) and diastolic blood pressure (DBP), assessed as 24-hour, daytime, and nighttime values. Separate logistic regression models were adjusted for age and sex. Standardized (z-score) analyses were performed to compare the relative strength of SBP and DBP associations. Results: A total of 941 hypertensive individuals were included (mean age 66.5 ± 11.7 years; 68.7% women; 54.9% with diabetes mellitus; 97.9% receiving 2 or more antihypertensive drug classes). Ambulatory blood pressure was associated with hypertensive retinopathy in a period-dependent manner, demonstrating a hierarchical pattern across ABPM parameters. Nighttime SBP showed a significant association with hypertensive retinopathy (OR 1.017 per mmHg; 95% CI 1.009–1.024; p < 0.001), alongside a similar independent association for daytime SBP (OR 1.015; 95% CI 1.007–1.024; p < 0.001), whereas 24-hour SBP was not independently associated with the outcome. DBP was independently associated with retinopathy across all periods, including nighttime (OR 1.022 per mmHg; 95% CI 1.011–1.034; p < 0.001). In standardized analyses, both systolic and diastolic pressures were strongly associated with retinopathy; nighttime DBP exhibited the largest standardized effect size, while nighttime SBP showed the most consistent circadian pattern. Conclusions: Hypertensive retinopathy was strongly associated with ambulatory blood pressure, with the strongest associations observed during the nighttime period. Both systolic and diastolic components contributed independently, highlighting complementary roles of pulsatile and sustained pressure load.
Gutemberg et al. (Fri,) studied this question.