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Daien V, Granados L, Kawasaki R, Villain M, Ribstein J, Du Cailar G, Mimran A, Fesler P. Retinal vascular caliber associated with cardiac and renal target organ damage in never-treated hypertensive patients. Microcirculation 2018; 24. [PMID: 27987377 DOI: 10.1111/micc.12344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between retinal vascular caliber and target organ damage in HT patients. METHODS Data were collected on cardiac, renal, vascular, and retinal variables in 88 consecutive never-treated HT subjects. Retinal vascular calibers were measured from fundus photographs by using a semi-automated computer-assisted program and summarized as CRAE and CRVE. RESULTS Mean CRAE and CRVE were significantly lower in patients with left ventricular hypertrophy (left ventricular mass ≥110 g/m² for women, 125 g/m² for men) than in those with normal left ventricular (CRAE: 129.4±3.7 vs 138.2±2.3 μm; P=.04; CRVE: 195.6±4.4 vs 209.8±2.7 μm; P=.008). CRAE and CRVE were negatively correlated with urinary albumin excretion (β±SE=-15.4±3.2, P<.0001 and β±SE=-11.9±4.4, P=.001, respectively) but were not correlated with estimated glomerular filtration rate (P=.21 and P=.75, respectively), carotid-to-femoral pulse wave velocity (P=.24 and P=.14), or carotid augmentation index (P=.43 and P=.16). CONCLUSION In never-treated HT patients, reduced CRAE and CRVE were associated with cardiac and renal preclinical damage, ie, left ventricular hypertrophy and albuminuria, but not estimated glomerular filtration rate or vascular stiffness.
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Affiliation(s)
- Vincent Daien
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1061, Montpellier, France
| | - Loic Granados
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Max Villain
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Jean Ribstein
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Guilhem Du Cailar
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Albert Mimran
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Pierre Fesler
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France.,PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier 34295 Montpellier Cedex 5, France
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Fuchs SC, Pakter HM, Maestri MK, Beltrami-Moreira M, Gus M, Moreira LB, Oliveira MM, Fuchs FD. Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition? PLoS One 2015; 10:e0136678. [PMID: 26375034 PMCID: PMC4572709 DOI: 10.1371/journal.pone.0136678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022] Open
Abstract
Background Retinal arterial narrowing is associated with higher office blood pressure (BP) and ambulatory blood pressure monitoring, and increased incidence of cardiovascular disease, but it is still unknown if the vessel caliber is associated with BP measured at the time of retinography acquisition. Methods Retinal arteriolar and venular calibers were measured by the microdensitometric method in 448 patients with hypertension. Participants underwent 24-hours ambulatory blood pressure (24-h ABP) monitoring simultaneously with the retinography acquisition. Association between arteriolar and venular calibers with increase of 10 mmHg in the mean 24-hours, daily, and nightly BP, and with BP measured at the time of retinography, was evaluated by ANOVA and multivariate analyses. Results Mean 24-hours, daytime and nighttime systolic and diastolic BP were inversely associated with the arteriolar caliber, but not with the venular caliber. Arteriolar caliber decreased -0.8 (95% CI -1.4 to -0.2) μm per 10-mmHg increase in 24-hours mean systolic BP, adjusted for age, gender, fellow vessel, and duration of hypertension (P = 0.01). The corresponding decreasing in arteriolar caliber by 10 mmHg of increasing in mean diastolic BP was -1.1 μm (-2.0 to -0.2, P = 0.02). The decrease of arteriolar caliber by the same increasing of BP measured at the time of retinography was lower and not statistically significant, particularly for mean diastolic BP and outer arterioles calibers: -1.0 (-1.8 to -0.2) μm in the daytime BP average versus -0.3 (-0.9 to 0.3) at the moment of retinography acquisition. Conclusions These findings suggest that the caliber of arteriolar retinal vessels in patients with uncontrolled hypertension are not significantly influenced by blood pressure measured at the time of retinography acquisition.
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Affiliation(s)
- Sandra C. Fuchs
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- * E-mail:
| | - Helena M. Pakter
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Marcelo K. Maestri
- Division of Ophthalmology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2350, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Marina Beltrami-Moreira
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Miguel Gus
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Leila B. Moreira
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
| | - Manuel M. Oliveira
- Informatics Institute, Universidade Federal do Rio Grande do Sul, Caixa Postal 15064, CEP 91501–970, Porto Alegre, RS, Brazil
| | - Flavio D. Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, and Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035–003, Porto Alegre, RS, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Hospital de Clinicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
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Coll-de-Tuero G, González-Vázquez S, Rodríguez-Poncelas A, Barceló MA, Barrot-de-la Puente J, Penedo MG, Pose-Reino A, Pena-Seijo M, Saez M. Retinal arteriole-to-venule ratio changes and target organ disease evolution in newly diagnosed hypertensive patients at 1-year follow-up. ACTA ACUST UNITED AC 2013; 8:83-93. [PMID: 24239162 DOI: 10.1016/j.jash.2013.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/20/2013] [Accepted: 10/02/2013] [Indexed: 11/16/2022]
Abstract
There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (>0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08-206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03-6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- Research Unit, Institut d'Assistència Sanitària, IAS, Girona, Spain; CIBER of Epidemiology and Public Health, CIBERESP, Spain; Department of Medical Sciences, University of Girona, Girona, Spain
| | - Sonia González-Vázquez
- Artificial Vision and Pattern Recognition Group, VARPA, Department of Computing, University of A Coruña, Spain
| | | | - María Antònia Barceló
- CIBER of Epidemiology and Public Health, CIBERESP, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain
| | | | - Manuel G Penedo
- Artificial Vision and Pattern Recognition Group, VARPA, Department of Computing, University of A Coruña, Spain
| | - Antonio Pose-Reino
- Internal Medicine Service, Hospital de Conxo, Santiago de Compostela, Spain
| | - Marta Pena-Seijo
- Internal Medicine Service, Hospital de Conxo, Santiago de Compostela, Spain
| | - Marc Saez
- CIBER of Epidemiology and Public Health, CIBERESP, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain.
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Target organ damage in hypertensive patients: correlation between retinal arteriovenular ratio and left ventricular geometric patterns. J Hum Hypertens 2013; 28:274-8. [PMID: 23903196 DOI: 10.1038/jhh.2013.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/14/2013] [Accepted: 06/19/2013] [Indexed: 12/22/2022]
Abstract
Early evaluation of cardiovascular (CV) risk in hypertensive patients is of primary importance and studies of retinal vessels can be helpful. The aim of this study is to assess the correlation between retinal vessel changes and target organ damage (TOD), expressed as left ventricular remodelling (LVR) or hypertrophy (LVH). We evaluated 60 treated hypertensive individuals (mean age 60.9±13.3 years). On the basis of echocardiographic results, we divided the subjects showing the presence of TOD and subjects without TOD into Groups A and B, respectively. Both groups underwent a non-mydriatic digital retinography. The obtained vessel images were analysed using dedicated software in order to calculate AVR (arteriovenular ratio), index of the retinal arteriolar narrowing. The data analyses confirmed a mean AVR value of 0.86 in Group B and a mean value of 0.77 in Group A. AVR index was also analysed in a subgroup of A with evidence of LVR, and mean value was 0.76. The same procedure was carried out with subgroup of A with LVH and AVR index resulted 0.77. In all comparisons, P-value was statistically significant (P<0.05). Our findings provide evidence that in hypertensive patients retinal AVR correlates with the presence of TOD, in this study in the context of LVR and LVH. In conclusion, AVR offers a direct vision retinal microcirculation and, also, indirectly, provides information of the left ventricular geometric pattern in hypertensive patients; thus, AVR may have an important role in global CV risk stratification and could possibly be used for optimising the hypertensive patient management.
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Similarities and differences in early retinal phenotypes in hypertension and diabetes. J Hypertens 2011; 29:1667-75. [DOI: 10.1097/hjh.0b013e3283496655] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cuspidi C, Negri F, Giudici V, Sala C. Retinal changes and cardiac remodelling in systemic hypertension. Ther Adv Cardiovasc Dis 2009; 3:205-14. [DOI: 10.1177/1753944709103220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The clinical value of left ventricular hypertrophy (LVH), a cardinal manifestation of hypertensive organ damage, in predicting cardiovascular (CV) events, independently of blood pressure (BP) and other accompanying risk factors, has been widely documented and its role in CV stratification indisputability recognized. Although the examination of the fundus oculi provides a unique opportunity to evaluate retinal microvascular abnormalities, which may mirror systemic arteriolar damage due to high BP, no consistent evidence exists, on the prognostic value of mild degrees of retinopathy, encompassing the vast majority of uncomplicated hypertensive subjects. Personal and literature data indicate that: (1) there is a tight association between advanced retinopathy and LVH suggesting the existence of a parallel involvement of retinal tree and cardiac damage in severe untreated or poorly controlled hypertension; (2) in contrast, a firm conclusion about the relationship between early or nonspecific retinal changes (narrowing or arteriovenous crossing) and cardiac damage is not allowed by the majority of the studies; (3) future investigations, based on computer-assisted methods, are further required to document the relation between initial retinal changes with organ damage and more importantly to test their predictive value for clinical outcomes.
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Affiliation(s)
- Cesare Cuspidi
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Istituto Auxologico Italiano, Milano, Italy,
| | - Francesca Negri
- Istituto Auxologico Italiano, Milano, Italy, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano
| | | | - Carla Sala
- Istituto di Medicina Cardiovascolare, Ospedale Maggiore Policlinico and University of Milano, Italy
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Tikellis G, Arnett DK, Skelton TN, Taylor HW, Klein R, Couper DJ, Richey Sharrett A, Yin Wong T. Retinal arteriolar narrowing and left ventricular hypertrophy in African Americans. the Atherosclerosis Risk in Communities (ARIC) study. Am J Hypertens 2008; 21:352-9. [PMID: 18246060 DOI: 10.1038/ajh.2007.57] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Whether microvascular disease contributes to the development of left ventricular hypertrophy (LVH) is unclear. We examined the relationship of retinal microvascular signs with LVH in an African-American population. METHODS A population-based, cross-sectional study of 1,439 middle-aged African-American participants in Jackson, Mississippi. A retinal photograph of one randomly selected eye was obtained and graded for presence of retinal microvascular signs (focal arteriolar narrowing, arterio-venous (AV) nicking, and retinopathy) according to standardized protocols. Retinal vessel diameter was measured from a computer-assisted technique to define generalized arteriolar narrowing. LVH was defined from standardized echocardiography. RESULTS In age and gender-adjusted models, retinal microvascular signs (except non-diabetic retinopathy) were significantly associated with LVH, with an odds ratio (OR) of 1.64 (95% confidence interval (CI) 1.29-2.09) for generalized arteriolar narrowing, OR 1.82 (95% CI 1.33-2.50) for focal arteriolar narrowing, and OR 1.35 (95% CI 1.02-1.79) for AV nicking. With further adjustment for cardiovascular (serum total cholesterol, fasting glucose, diabetes, diabetes duration, smoking, body mass index (BMI), waist-to-hip ratio, and exercise level) and hypertension-related factors (mean arterial blood pressure (MABP) at the time of retinal photography and antihypertensive medication use), associations were attenuated but remained significant for generalized and focal arteriolar narrowing, with OR 1.35 (95% CI 1.02-1.78) and OR 1.66 (95% CI 1.16-2.38), respectively. CONCLUSIONS Middle-aged African Americans with generalized and focal retinal arteriolar narrowing were more likely to have LVH. This association was explained only partly by cardiovascular risk factors and hypertension.
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