Analysis of retinal arteriolar structure in never-treated patients with essential hypertension

Ritt, Martin; Harazny, Joanna; Ott, Christian; Schlaich, Markus P.; Schneider, Markus P.; Michelson, Georg; Schmieder, Roland E.

doi:10.1097/hjh.0b013e3282ffdc66

Cited by 101 publications

(96 citation statements)

References 34 publications

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“…13 Indeed, by using SLDF, we could show that WLR of retinal arterioles is increased in patients with hypertension and cerebrovascular events compared with treated hypertensives and normotensives. 17 Moreover, we have shown that WLR seems to be a robust indicator of the severity of hypertension, 26 the presence of early renal damage, 27 and, in contrast with arteriolar-to-venular ratio, is related to the extent of atherosclerotic damage in the carotid artery, as indicated by evaluation of the intima-media thickness. 28 Hence, the major and novel finding of this observational study is that central PP is a strong and an independent predictor of vascular remodeling (WLR) in the retinal circulation beyond classical CV risk factors and additional factors that are proposed to have an impact on vascular structure.…”

Section: Discussionmentioning

confidence: 99%

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

et al. 2013

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A lthough the importance of hypertension as predictor of coronary heart disease and stroke has been known for a long time, the relative contribution of the individual components of peripheral blood pressure (BP) to the development of cardiovascular (CV) disease is still a matter of debate. [1][2][3][4][5] More striking nowadays, the importance of central hemodynamics is more and more acknowledged. Pathophysiologically, it seems consistent that the estimation of the central pressure in the aorta, which is actually the perfusion pressure to key organs, rather than the pressure in the arm, provides more relevant prognostic information. Indeed, it has been shown in a population-based study (the Strong Heart Study) 6 and in a hypertension trial (the Conduit Artery Function Evaluation [CAFÉ] study) 7 that the noninvasively measured central BP is superior to brachial BP in predicting CV outcomes. In a comprehensive review, Laurent et al 8 summarized the evidence that central pressure and pulse pressure (PP) are superior indicators of incident CV disease in a variety of prospective studies. Vascular remodeling, characterized by an increased mediato-lumen ratio (M/L) of small resistance and large arteries, has been identified as one of the early processes that occurs in response to increased BP and leads to hypertensive endorgan damage.9,10 The prognostic role of structural alterations of isolated subcutaneous small arteries and arterioles has been shown in arterial hypertension, with adverse prognosis in those patients with an increased M/L. 11,12 Moreover, in a former study it was shown that, although all known CV risk factors were considered, only PP and M/L were significantly associated with the occurrence of CV events. 11However, the evaluation of small artery and arteriolar structure of isolated subcutaneous small vessels requires an invasive procedure, namely the performance of a biopsy of subcutaneous tissue. Hence, this methodology is inadequate for routine patient management. In contrast, the analysis of the retinal vessels offers the opportunity to visualize the microvasculature of the body noninvasively, repeatedly, and safely in vivo. Hence, a new approach focuses on retinal arteriolar structural parameters by using scanning laser Doppler flowmetry (SLDF).Previously, both methodologies SLDF (in vivo) and myograph (in vitro) were assessed in patients with hypertension and normotensive controls. A close correlation was observed between M/L of subcutaneous small arteries and wall-to-lumen ratio (WLR) of retinal arteries, indicating that SLDF may provide similar information about microvascular morphology compared with an invasive, accurate, and prognostically Abstract-Pulse pressure has been recognized as a risk factor for stroke. Moreover, it was shown that central pulse pressure relates more strongly to vascular disease and outcome than (peripheral) brachial pulse pressure. Because vascular remodeling in the retinal circulation mirrors the 1 in the cerebral circulation and represents an easy, noninvasive possi...

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Section: Discussionmentioning

confidence: 99%

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

et al. 2013

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“…36 Mechanisms underlying the association of BP and retinal arterioles have been previously hypothesized. 3,38,39 Arteriolar narrowing is thought to result from cumulative arteriolar changes associated with remodeling from chronic hypertension and arteriolosclerosis. 3,38 Our findings showed that retinal arteriolar narrowing remained evident even in individuals whose BP had been lowered by antihypertensive therapy, suggesting persistent arteriolar damage from chronic hypertension.…”

Section: Discussionmentioning

confidence: 99%

Effect of blood pressure on the retinal vasculature in a multi-ethnic Asian population

et al. 2009

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Blood pressure has a significant effect on retinal arterioles. There are few data on whether this effect varies by race/ethnicity. We examined the relationship of blood pressure and retinal vascular caliber in a multi-ethnic Asian population. The study is population-based and cross sectional in design. A total of 3749 Chinese, Malay and Indian participants aged X24 years residing in Singapore were included in the study. Retinal vascular caliber was measured using a computer program from digital retinal photographs. The associations of retinal vascular caliber with blood pressure and hypertension in each racial/ethnic group were analyzed. The main outcome measures are retinal arteriolar caliber and venular caliber. The results show that retinal arterioles were narrower in persons with uncontrolled/untreated hypertension (140.0 lm) as compared with persons with controlled hypertension (142.1 lm, P¼0.0001) and those with no hypertension (146.0 lm, Po0.0001). On controlling for age, gender, body mass index, lipids and smoking, each 10 mm Hg increase in mean arterial blood pressure was associated with a 3.1 lm decrease in arteriolar caliber (Po0.0001), with a similar magnitude seen in all three racial/ethnic groups: 3.1 lm in Chinese, 2.8 lm in Malays and 3.2 lm in Indians (Po0.0001 for all). Each 10 mm Hg increase in mean arterial blood pressure was associated with a 1.8 lm increase in venular caliber (Po0.0001); furthermore, the magnitude of this effect was similar across the three racial/ethnic groups. The effect of blood pressure on the retinal vasculature was similar across three major racial/ethnic groups in Asia.

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“…99 Using such approach, an increased wall:lumen ratio of retinal arterioles was initially demonstrated in treated hypertensive patients with cerebrovascular event, 100 as well as in untreated hypertensive patients. 101 Further recent studies report that increased wall:lumen ratio of retinal arterioles is correlated with increased BP, urinary albumin excretion, and cerebrovascular damage. [100][101][102][103] Compared with assessment of retinal arteriolar narrowing with retinal fundus photography, assessing wall:lumen ratio of retinal arterioles may provide further indication on vascular remodeling, but its prognostic significance has not yet been evaluated in prospective studies, and the technical availability of scanning laser Doppler flowmetry is limited.…”

Section: Assessment Of Retinal Vascular Flowmentioning

confidence: 99%

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

Cheung

Ikram²,

Sabanayagam³

et al. 2012

Hypertension

224

166

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The retinal vasculature allows direct noninvasive visualization of the body’s mircrovasculature. Because the retina and other end organs (brain and kidney) share similar anatomical features and physiological properties, the retinal vessels offer a unique and easily accessible window to study the health and disease of the human microcirculation. Advanced retinal vascular imaging technologies have been developed to allow a more objective and precise assessment of retinal vascular changes. The changes in the retinal vasculature associated with hypertension can be broadly divided into 3 groups: (1) classic retinal vascular changes in response to blood pressure (referred to as hypertensive retinopathy signs), (2) changes in retinal vascular caliber, and (3) changes in more global geometrical patterns of the retina. In this review, we summarize the current understanding of the relationship between retinal vascular changes and blood pressure, the evidence for the retinal vasculature as a biological model to study the manifestation and early pathogenic correlates of hypertension, the latest advances in retinal vascular imaging technologies, and the future opportunities and challenges of retinal vascular imaging. We suggest that further development of retinal vascular analyses and standardized measurement protocols, evaluation of the clinical use of retinal vascular imaging in assessing cardiovascular risk prediction, and using retinal vascular imaging to test antihypertensive treatments will allow the translation of retinal vascular imaging as a tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.

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Analysis of retinal arteriolar structure in never-treated patients with essential hypertension

Cited by 101 publications

References 34 publications

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

Effect of blood pressure on the retinal vasculature in a multi-ethnic Asian population

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

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