Value of routine funduscopy in patients with hypertension: systematic review

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 kappa 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.