Racial Disparities in Heart Failure Outcomes Among Patients With Hypertensive Retinopathy: A Multicenter Real-World Analysis

Abstract

Background: Hypertensive retinopathy is a microvascular manifestation of chronic hypertension and a prognostic marker for systemic cardiovascular damage. However, the relationship between hypertensive retinopathy and heart failure outcomes across racial groups remains poorly understood.

Objective: To evaluate racial disparities in the incidence of acute heart failure among patients with hypertensive retinopathy using a large multicenter electronic health record network.

Methods: A retrospective cohort study was conducted using the TriNetX Research Network (2010–2021). Adult patients with diagnoses of hypertension and hypertensive retinopathy were identified and stratified by race (Black vs. White). Propensity score matching (1:1) was performed across 34 covariates, including comorbidities, medications, and laboratory parameters. The primary outcome was acute heart failure (new-onset or acute-on-chronic), analyzed over 3 years of follow-up using Cox proportional hazards models.

Results: After matching, 49,114 patients (mean age 68.7 years; 61.2% female) were included. Black patients had a higher incidence of acute heart failure compared with White patients (10.9% vs. 9.7%; HR 1.125, 95% CI 1.064–1.189). Black individuals also exhibited higher rates of related adverse outcomes, including cardiac arrest (HR 1.45) and ventricular tachycardia (HR 1.30). These findings persisted despite balanced baseline characteristics, suggesting underlying racial disparities in heart failure risk among patients with hypertensive retinopathy.

Conclusions: Among individuals with hypertensive retinopathy, Black patients experienced a significantly higher risk of heart failure compared to White patients. This highlights the prognostic value of hypertensive retinopathy as a marker of subclinical cardiac dysfunction and underscores the need for targeted prevention strategies addressing racial inequities in heart failure care.