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The performance of an integrated model including retinal information in predicting childhood hypertension



The objective of this study was to examine the association of an integrated model (composed of retinal arteriolar caliber, height, and sex) with blood pressure (BP) among a group of Chinese children, and assess the predictive value of the integrated model for childhood hypertension.


This study included 1460 candidates aged 12.634 ± 0.420 years. Height, weight, waist circumference, and BP were obtained and ophthalmological measurements were taken. The computer-imaging program (IVAN, University of Wisconsin, Madison, WI) was used to measure calibers of retinal vessels. Receiver-operating characteristic curve (ROC) analyses were performed to assess the accuracy of the integrated model as a diagnostic test of elevated BP in children.


The accuracy of the integrated model (assessed by area under the curve) for identifying elevated BP was 0.777 (95% confidence interval: 0.742–0.812). The optimal threshold of the integrated model for defining hypertension was 0.153, and the calculation formula for the specific predictive risk was: Logit (p/1 − p) = −5.666 − 0.261 × retinal arteriolar caliber + 0.945 × sex + 0.438 × height. In identifying elevated BP, the sensitivity and specificity were 0.711 and 0.736, respectively.


The model containing eye message is a comprehensive and relatively effective index to identify elevated BP in 12-year-old children, which can offer assistance to further understand childhood microcirculation disease.


  • We firstly incorporated retinal vascular diameter, sex, and height into one integrated model to identify hypertension in 12-year-old children.

  • The current discrimination of hypertension in children is difficult. There have been some studies to simplify the diagnosis of children’s hypertension, but they were limited to anthropometric measurements. We proposed a composed model containing microcirculation information to predict childhood hypertension.

  • Based on the knowledge that microcirculation is not only a means to study the manifestations but also early pathogenic correlates of hypertension, the combined model containing microcirculation message as a method may provide new insights into the diagnosis of childhood hypertension.

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Fig. 1: The flowchart of participants for this study.


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We thank the support from the Anyang city government for helping to organize the survey. We acknowledge the UW Fundus Photograph Reading Center and Nicola Ferrier of the School of Engineering at UW for providing the software for measuring retinal vessel calibers. This work was supported by grants from the capital health research and development of special (2020-2-1081), Beijing Talents Found (2016000021223ZK28), the National Natural Science Foundation of China (82071000), and Beijing Natural Science Foundation (JQ20029).

The Anyang Childhood Eye Study Group

STUDY CHAIR’S OFFICE: Ningli Wang4, Shi-Ming Li4, Luo-Ru Liu5, Paul Mitchell6; COORDINATING CENTER: Xiuzi Zhou7, Weixin He8, Wenjie Li5, Yazhou Ji5, Fangrong Shi5, Jiyuan Guo5; MAIN INVESTIGATORS: Fengju Zhang4, Si-Yuan Li4, Meng-Tian Kang4, Jin Fu4, Lei Li4, Shiqiang Zhao4, Yang Wang4, Yan Xu4, Zhou Yang4, Bi-Dan Zhu9, Yazhou Ji5, Hailin Meng5, He Li5, Fangrong Shi5, Yongfang Tu5, Yipeng Wang5, Hongliang Zhang5, Donghai Yang5, Wenfang Niu5, Jinling Li5, Jiyuan Guo5, Baohong Han5, Lin Jia5, Zuowei Qi5, Zhenhuai Kang5, Bing Cao5, Xianfang Du5, Yicao Zhang5, Chuanqi Xie5, Bingqi Zhang5, Songtao Li5, Xiaoyuan Yang10, Bo Wang11; COMMITTEES Data and Safety Monitoring: Si-Yan Zhang12, Hongyuan Wang12, Xiaoxia Peng13, Lei Li4

Author information





Y.H.: drafting manuscript and data analysis/interpretation; S.-M.L.: concept and design; Q.Z.: data analysis/interpretation; K.C.: data analysis/interpretation and statistical analysis; M.-T.K.: data acquisition and data analysis/interpretation; L.-R.L.: data acquisition, admin, technical, or material support; H.L.: data acquisition, admin, technical, or material support; N.W.: concept and design, and supervision and final approval.

Corresponding author

Correspondence to Ningli Wang.

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The authors declare no competing interests.

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Informed written consent was obtained from at least one parent. Verbal assent was obtained from each child.

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He, Y., Li, SM., Zhang, Q. et al. The performance of an integrated model including retinal information in predicting childhood hypertension. Pediatr Res (2021).

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