Retinal Vessel Narrowing: A Prehypertensive or Masked Hypertensive State?

Based on analyses of Rotterdam Study data, Ikram et al 1 concluded that retinal vessel narrowing might precede the development of systemic hypertension.The authors have made a great effort to optimize the ophthalmoscopic technique and achieved a more sensitive method than those used previously.On the other hand, baseline blood pressure measurements were rather "old-fashioned," composed of 2 readings taken during a single visit.In an analogy to the authors' conclusion that, compared with their methodology, "(standard ophthalmoscopy) may underestimate the extent of arteriolar narrowing and thereby the risk of hypertension," one may suggest that, in some subjects, blood pressure at baseline was underestimated by the standard clinic measurement.Thus, if in addition to the 2871 subjects excluded because of hypertension at screening, another 10% to 20% 2,3 (Ϸ430 subjects) had masked hypertension at baseline, the true incidence of new hypertension (nϭ808) is probably overestimated.Therefore, a finding of retinal vessel narrowing in a subject with normal clinic blood pressure may indicate either a prehypertensive state (as the authors imply), or, not less likely, a masked hypertensive state.Ambulatory blood pressure monitoring may identify the true condition. 4