Hypertensive Retinopathy and Differential Cardiovascular Risk in Black and White Populations

Background: Hypertensive retinopathy reflects systemic microvascular injury and serves as a prognostic marker for cardiovascular risk. Racial disparities in hypertension-related outcomes are well documented, but limited data exist on whether the presence of hypertensive retinopathy confers differential cardiovascular risk across Black and White populations. Methods: In this retrospective cohort study using the TriNetX Research Network (2010-2021), we analyzed 49 14 propensity score-matched adults (24 557 Black and 24 557 White) with diagnoses of hypertension and hypertensive retinopathy. Baseline characteristics were balanced across 34 variables. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for major cardiovascular outcomes. Results: Black patients with hypertensive retinopathy had significantly higher rates of all-cause hospitalization (46.4% vs. 43.9%; HR 1.076, 95% CI 1.048-1.105), acute heart failure (10.9% vs. 9.7%; HR 1.125, 95% CI 1.064-1.189), myocardial infarction (5.7% vs. 5.0%; HR 1.139, 95% CI 1.055-1.230), and ischemic stroke (9.7% vs. 7.9%; HR 1.228, 95% CI 1.157-1.304). Atrial fibrillation/flutter was less common in Black patients (8.9% vs. 10.4%; HR 0.848, 95% CI 0.801-0.898). Conclusions: Among patients with hypertensive retinopathy, Black individuals experienced worse cardiovascular outcomes compared to White individuals. These findings highlight the importance of hypertensive retinopathy as a clinical risk marker and emphasize the need for equitable, targeted interventions to mitigate racial disparities in hypertension-related complications.