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Meng Y, Liu L, Chen X, Zhao L, She H, Zhang W, Zhang J, Qin X, Li J, Xu X, Wang B, Hou F, Tang G, Liao R, Huo Y, Li J, Yang L. Associations between brachial-ankle pulse wave velocity and hypertensive retinopathy in treated hypertensive adults: Results from the China Stroke Primary Prevention Trial (CSPPT). J Clin Hypertens (Greenwich) 2024; 26:724-734. [PMID: 38683601 PMCID: PMC11180693 DOI: 10.1111/jch.14820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024]
Abstract
Although the association between persistent hypertension and the compromise of both micro- and macro-circulatory functions is well recognized, a significant gap in quantitative investigations exploring the interplay between microvascular and macrovascular injuries still exists. In this study, the authors looked into the relationship between brachial-ankle pulse wave velocity (baPWV) and hypertensive retinopathy in treated hypertensive adults. The authors conducted a cross-sectional study of treated hypertensive patients with the last follow-up data from the China Stoke Primary Prevention Trial (CSPPT) in 2013. With the use of PWV/ABI instruments, baPWV was automatically measured. The Keith-Wagener-Barker classification was used to determine the diagnosis of hypertensive retinopathy. The odds ratio (OR) and 95% confidence interval (CI) for the connection between baPWV and hypertensive retinopathy were determined using multivariable logistic regression models. The OR curves were created using a multivariable-adjusted restricted cubic spline model to investigate any potential non-linear dose-response relationships between baPWV and hypertensive retinopathy. A total of 8514 (75.5%) of 11,279 participants were diagnosed with hypertensive retinopathy. The prevalence of hypertensive retinopathy increased from the bottom quartile of baPWV to the top quartile: quartile 1: 70.7%, quartile 2: 76.1%, quartile 3: 76.7%, quartile 4: 78.4%. After adjusting for potential confounders, baPWV was positively associated with hypertensive retinopathy (OR = 1.05, 95% CI, 1.03-1.07, p < .001). Compared to those in the lowest baPWV quartile, those in the highest baPWV quartile had an odds ratio for hypertensive retinopathy of 1.61 (OR = 1.61, 95% CI: 1.37-1.89, p < .001). Two-piece-wise logistic regression model demonstrated a nonlinear relationship between baPWV and hypertensive retinopathy with an inflection point of 17.1 m/s above which the effect was saturated .
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Affiliation(s)
- Ying Meng
- Department of OphthalmologyPeking University First HospitalBeijingChina
- Department of OphthalmologyPeking University International HospitalBeijingChina
| | - Lishun Liu
- Graduate School at ShenzhenTsinghua UniversityBeijingChina
| | - Xuling Chen
- Department of Ophthalmologythe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Liang Zhao
- Department of OphthalmologyPeking University First HospitalBeijingChina
| | - Haicheng She
- Beijing Tongren Eye Center, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
- Beijing Ophthalmology and Visual Science Key LaboratoryBeijingChina
| | - Wenbo Zhang
- Department of OphthalmologyPeking University First HospitalBeijingChina
| | - Jing Zhang
- Department of OphthalmologyPeking University First HospitalBeijingChina
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Jianping Li
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Xiping Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Binyan Wang
- School of Health AdministrationAnhui UniversityHefeiChina
| | - Fanfan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Genfu Tang
- School of Health AdministrationAnhui UniversityHefeiChina
| | - Rongfeng Liao
- Department of Ophthalmologythe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Yong Huo
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Jun Li
- Department of OphthalmologyPeking University First HospitalBeijingChina
| | - Liu Yang
- Department of OphthalmologyPeking University First HospitalBeijingChina
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2
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Li J, Zhang W, Zhao L, Zhang J, She H, Meng Y, Zhang Y, Gu X, Zhang Y, Li J, Qin X, Wang B, Xu X, Hou F, Tang G, Liao R, Liu L, Huang M, Bai X, Huo Y, Yang L. Positive correlation between hypertensive retinopathy and albuminuria in hypertensive adults. BMC Ophthalmol 2023; 23:66. [PMID: 36782153 PMCID: PMC9923927 DOI: 10.1186/s12886-023-02807-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE We investigated the association between albuminuria and hypertensive retinopathy (HR) in hypertensive adults. METHODS This was a cross-sectional subgroup analysis of data from the China Stroke Primary Prevention Trial. We enrolled 2,964 hypertensive adults in this study. Keith-Wagener-Barker stages was used to assess HR. The urinary albumin to creatinine ratio (UACR) was calculated to evaluate albuminuria. RESULTS HR was found in 76.6% (n = 2, 271) of the participants, albuminuria was found in 11.1% (n = 330). The UACR levels were significantly higher in subjects with HR than in those without HR (grade 1, β = 1.42, 95% confidence intervals [CI]: -0.12, 2.95, p = 0.070; grade 2, β = 2.62, 95% CI: 0.56, 4.67, p = 0.013; grade 3, β = 5.17, 95% CI: 1.13, 9.20, p = 0.012). In the subgroup analyses, the association between HR and UACR was stronger in current smokers (p for interaction = 0.014). The correlation between HR grades 1 and 2 and UACR was stronger in subjects with higher triglyceride levels (≥ 1.7 mmol/L), but for grade 3 HR, this correlation was stronger in subjects with lower triglycerides levels (< 1.7 mmol/L, p for interaction = 0.023). The odds of albuminuria were significantly higher in subjects with HR than in those without HR (grade 1, odds ratio [OR] = 1.57, 95% CI: 1.08, 2.29, p = 0.019; grade 2, OR = 2.02, 95% CI: 1.28, 3.18, p = 0.002; grade 3, OR = 2.12, 95% CI: 0.99, 4.55, p = 0.053). In the subgroup analyses, the association between HR grades 1 and 2 and albuminuria was stronger in subjects with higher triglycerides levels (≥ 1.7 mmol/L), but for grade 3 HR, this correlation was stronger in subjects with lower triglyceride levels (< 1.7 mmol/L, p for interaction = 0.014). CONCLUSION HR was positively correlated with albuminuria in hypertensive Chinese adults. This correlation was more remarkable when the population was stratified by triglycerides levels and smoking status. HR can be used as an indicator of early renal injury.
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Affiliation(s)
- Jun Li
- grid.411472.50000 0004 1764 1621Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Wenbo Zhang
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Liang Zhao
- grid.411472.50000 0004 1764 1621Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Jing Zhang
- grid.411472.50000 0004 1764 1621Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Haicheng She
- grid.414373.60000 0004 1758 1243Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Meng
- grid.449412.eDepartment of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Yadi Zhang
- grid.411472.50000 0004 1764 1621Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Xiaopeng Gu
- grid.411472.50000 0004 1764 1621Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Yan Zhang
- grid.411472.50000 0004 1764 1621Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Jianping Li
- grid.411472.50000 0004 1764 1621Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Xianhui Qin
- grid.416466.70000 0004 1757 959XNational Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Binyan Wang
- grid.186775.a0000 0000 9490 772XInstitute of Biomedicine, Anhui Medical University, Hefei, China
| | - Xiping Xu
- grid.416466.70000 0004 1757 959XNational Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China ,grid.22935.3f0000 0004 0530 8290Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Fanfan Hou
- grid.416466.70000 0004 1757 959XNational Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Genfu Tang
- grid.252245.60000 0001 0085 4987School of Health Administration, Anhui University, Hefei, China
| | - Rongfeng Liao
- grid.412679.f0000 0004 1771 3402Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lishun Liu
- grid.12527.330000 0001 0662 3178Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Meiqing Huang
- Data Management Center, Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Xinlei Bai
- grid.254147.10000 0000 9776 7793China Pharmaceutical University, Nanjing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Cheung CY, Biousse V, Keane PA, Schiffrin EL, Wong TY. Hypertensive eye disease. Nat Rev Dis Primers 2022; 8:14. [PMID: 35273180 DOI: 10.1038/s41572-022-00342-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
Abstract
Hypertensive eye disease includes a spectrum of pathological changes, the most well known being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (for example, kidney disease) elsewhere in the body. Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification.
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Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Valérie Biousse
- Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Ernesto L Schiffrin
- Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. .,Tsinghua Medicine, Tsinghua University, Beijing, China.
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4
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Matsuoka S, Kaneko H, Kamon T, Suzuki Y, Yano Y, Okada A, Itoh H, Morita K, Fukui A, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Nakamura S, Yokoo T, Nishiyama A, Node K, Yasunaga H, Komuro I. Incorporation of Retinal Arteriolosclerosis into Risk Stratification of Blood Pressure Category According to the 2017 ACC/AHA Blood Pressure Guideline. J Atheroscler Thromb 2021; 29:1487-1498. [PMID: 34866070 PMCID: PMC9529405 DOI: 10.5551/jat.63262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: We investigated whether retinal arteriolosclerosis (RA) could be used for cardiovascular disease (CVD) risk stratification of individuals categorized according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Blood Pressure (BP) guideline.
Methods: We studied 291,522 participants without a history of CVD and not taking any BP-lowering medications from the JMDC Claims Database. RA was defined as Keith–Wagener–Barker system grade ≥ 1. Each participant was classified into one of the six groups: (1) normal or elevated BP without RA, (2) normal or elevated BP with RA, (3) stage 1 hypertension without RA, (4) stage 1 hypertension with RA, (5) stage 2 hypertension without RA, and (6) stage 2 hypertension with RA.
Results: Median (interquartile range) age was 46 (40–53) years, and 141,397 (48.5%) of the participants were men. During a mean follow-up of 1,223±830 days, 527 myocardial infarction (MI), 5,718 angina pectoris, 2,890 stroke, and 5,375 heart failure (HF) events occurred. Multivariable Cox regression analyses revealed that the risk of CVD increased with BP category, and this association was pronounced by the presence of RA. Compared with normal or elevated BP without RA, the hazard ratios (HRs) for MI (HR 1.17, 95% CI 0.93–1.47) were higher in stage 1 hypertension without RA. The HRs for MI further increased in stage 1 hypertension with RA (1.86 [1.17–2.95]). This association was present in stroke and HF.
Conclusion: Incorporation of the assessment for RA may facilitate the CVD risk stratification of people classified based on the 2017 ACC/AHA BP guideline, particularly for those categorized in stage 1 hypertension.
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Affiliation(s)
- Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo.,The Department of Cardiology, New Tokyo Hospital
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo.,The Department of Advanced Cardiology, The University of Tokyo
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo.,Department of Rehabilitation Science, Graduate School of Medical Sciences, Kitasato University
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital.,The Department of Family Medicine and Community Health, Duke University
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, the University of Tokyo
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo.,The Department of Cardiology, New Tokyo Hospital
| | | | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo
| | | | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo
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5
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Matsuoka S, Kaneko H, Yano Y, Itoh H, Fukui A, Morita K, Kiriyama H, Kamon T, Fujiu K, Seki H, Michihata N, Jo T, Takeda N, Morita H, Nakamura S, Yokoo T, Nishiyama A, Node K, Yasunaga H, Komuro I. Association Between Blood Pressure Classification Using the 2017 ACC/AHA Blood Pressure Guideline and Retinal Atherosclerosis. Am J Hypertens 2021; 34:1049-1056. [PMID: 34008020 DOI: 10.1093/ajh/hpab074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We aimed to explore the association between the blood pressure (BP) classification defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and the prevalence of retinal atherosclerosis. METHODS This study was a retrospective observational cross-sectional analysis using the JMDC Claims Database. We analyzed 280,599 subjects not taking any antihypertensive medications. According to the 2017 ACC/AHA guideline, each subject was categorized as having normal BP (n = 159,524), elevated BP (n = 35,603), stage 1 hypertension (n = 54,795), or stage 2 hypertension (n = 30,677) using the BP value at the initial health checkup. Retinal photographs were assessed according to the Keith-Wagener-Barker system. RESULTS The median age was 46 years, and 50.4% subjects were men. Retinal atherosclerosis, defined as Keith-Wagener-Barker system grade ≥1, was observed in 3.2% in normal BP, 5.2% in elevated BP, 7.7% in stage 1 hypertension, and 18.7% in stage 2 hypertension. Compared with normal BP, elevated BP (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.23-1.38), stage 1 hypertension (OR, 1.71; 95% CI, 1.64-1.79), and stage 2 hypertension (OR, 4.10; 95% CI, 3.93-4.28) were associated with a higher prevalence of retinal atherosclerosis. Among 92,121 subjects without obesity, high waist circumference, diabetes mellitus, dyslipidemia, cigarette smoking, and alcohol consumption, elevated BP (OR, 1.34; 95% CI, 1.19-1.51), stage 1 hypertension (OR, 1.79; 95% CI, 1.61-1.98), and stage 2 hypertension (OR, 4.42; 95% CI, 4.00-4.92) were associated with a higher prevalence of retinal atherosclerosis. This association was observed in all subgroups stratified by age or sex. CONCLUSIONS Our investigation suggests that retinal atherosclerosis could start even in individuals with elevated BP and stage 1 hypertension.
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Affiliation(s)
- Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yano
- YCU Center for Novel and Exploratory Clinical Trials, Yokohama City University Hospital, Yokohama, Japan
- The Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Morita
- The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Hikari Seki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Sunao Nakamura
- The Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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