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Cífková R, Harazny JM, Bruthans J, Wohlfahrt P, Krajčoviechová AH, Lánská V, Gelžinský J, Mateřánková M, Mareš Š, Filipovský J, Mayer O, Schmieder RE. Early vascular damage in retinal microcirculation in arterial hypertension: the Czech post-MONICA study. J Hypertens 2024; 42:557-563. [PMID: 38088414 PMCID: PMC10842650 DOI: 10.1097/hjh.0000000000003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024]
Abstract
Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals. DESIGN AND METHOD A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n = 213), treated controlled hypertensive individuals ( n = 30), treated uncontrolled hypertensive individuals ( n = 26), and newly detected/untreated hypertensive individuals ( n = 73). RESULTS There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals. CONCLUSION Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Joanna M. Harazny
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander- University, Erlangen-Nürnberg, Germany
- Department of Human Physiology and Pathophysiology, University of Warmia and Mazury, Olsztyn, Poland
| | - Jan Bruthans
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
| | - Alena Hrubeš Krajčoviechová
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
| | - Věra Lánská
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Július Gelžinský
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Štěpán Mareš
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Otto Mayer
- 2nd Department of Internal Medicine, Faculty of Medicine, Charles University, Pilsen
| | - Roland E. Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander- University, Erlangen-Nürnberg, Germany
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Paini A, Agabiti Rosei C, De Ciuceis C, Aggiusti C, Bertacchini F, Cacciatore M, Capellini S, Gatta R, Malerba P, Stassaldi D, Rizzoni D, Salvetti M, Muiesan ML. Unattended versus Attended Blood Pressure Measurement: Relationship with Retinal Microcirculation. J Clin Med 2022; 11. [PMID: 36498540 DOI: 10.3390/jcm11236966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Though the relationship between both “attended” and “unattended” BP and several forms of target organ damage have been evaluated, data on retinal arteriolar alterations are lacking. The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and retinal arteriolar changes in consecutive individuals undergoing a clinical evaluation and assessment of retinal fundus at an ESH Excellence Centre. An oscillometric device programmed to perform 3 BP measurements, at 1 min intervals and after 5 min of rest was used on all individuals to measure BP with the patient alone in the room (“unattended”) or in the presence of the physician (“attended”) in the same day in a random order. The retinal arteriole’s wall thickness (WT) was measured automatically by a localization algorithm as the difference between external (ED) and internal diameter (ID) by adaptive optics (RTX-1, Imagine Eyes, Orsay, Francia). Media-to-lumen ratio (WLR) of the retinal arterioles and cross-sectional area (WCSA) of the vascular wall were calculated. Results: One-hundred-forty-two patients were examined (mean age 57 ± 12 yrs, 48% female, mean BMI 26 ± 4). Among them, 60% had hypertension (84% treated) and 11% had type 2 diabetes mellitus. Unattended systolic BP (SBP) was lower as compared to attended SBP (129 ± 14.8. vs. 122.1 ± 13.6 mmHg, p < 0.0001). WLR was similarly correlated with unattended and attended SBP (r = 0.281, p < 0.0001 and r = 0.382, p < 0.0001) and with unattended and attended diastolic BP (r = 0.34, p < 0.001 and r = 0.29, p < 0.0001). The differences between correlations were not statistically significant (Steiger’s Z test). Conclusion: The measurement of “unattended” or “attended” BP provides different values, and unattended BP is lower as compared to attended BP. In this study a similar correlation was observed between attended and unattended BP values and structural changes of retinal arterioles.
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Mehta RA, Akkali MC, Jayadev C, Anuj A, Yadav NK. Morphometric analysis of retinal arterioles in control and hypertensive population using adaptive optics imaging. Indian J Ophthalmol 2020; 67:1673-1677. [PMID: 31546506 PMCID: PMC6786142 DOI: 10.4103/ijo.ijo_253_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose: To measure the wall-to-lumen ratio (WLR) and the vascular wall cross-sectional area (WCSA) of retinal arterioles by an Adaptive Optics (AO) retinal camera using semi-automated software and comparing them between control and hypertensive population. Methods: This was a cross-sectional observational study including a hypertensive group and a control group. Subjects were examined and their medical history recorded. Retinal arteriolar morphometry was assessed by rtx1 AO retinal camera using AOdetect Artery semiautomated software. Main Outcome Measures: WLR and WCSA were measured on the basis of retinal arteriolar wall thickness (W1, W2), lumen diameter (LD) and vessel diameter (VD). Influence of age and arterial hypertension on the WLR and WCSA were examined. Results: A total of 150 human subjects were included out of which 110 were controls and 40 were hypertensives under treatment. There was statistically significant difference in the age, systolic and diastolic blood pressures between the control and hypertensive groups (P < 0.01). We found no significant correlation between age and WLR (R2 = 0.049, P > 0.05) or age and WCSA (R2 = 0.045, P > 0.05). We observed a significant difference in WLR and WCSA measurements between control and hypertensive groups (P < 0.01). On measuring intra-observer variability (IOV) we found excellent consistency. Conclusion: AO retinal imaging allows a direct measurement of the retinal vessel wall and LD with excellent IOV. WLR and WCSA reflect the remodelling process and can be used to further aid the early detection and monitoring of systemic hypertension.
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Affiliation(s)
- Ruchir A Mehta
- Department of Vitreoretina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Mukund C Akkali
- Department of Vitreoretina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Chaitra Jayadev
- Department of Vitreoretina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Aishwarya Anuj
- Department of Vitreoretina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Naresh K Yadav
- Department of Vitreoretina, Narayana Nethralaya, Bangalore, Karnataka, India
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Streese L, Brawand LY, Gugleta K, Maloca PM, Vilser W, Hanssen H. New Frontiers in Noninvasive Analysis of Retinal Wall-to-Lumen Ratio by Retinal Vessel Wall Analysis. Transl Vis Sci Technol 2020; 9:7. [PMID: 32821504 PMCID: PMC7408937 DOI: 10.1167/tvst.9.6.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/04/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare measurement of wall-to-lumen ratio (WLR) by means of high-resolution adaptive optics imaging (AO) with intuitive to use retinal vessel wall (VW) analysis (VWA). Moreover, to validate the techniques by comparing WLR of healthy young (HY) with healthy older patients. Methods Ten retinal VW images of 13 HY (24 ± 2 years) and 16 healthy older (60 ± 8 years) were obtained with AO and VWA. The average of five measurements of VW, retinal vessel lumen and WLR of a single vessel from AO and VWA were calculated and compared. Results WLR of AO and VWA images showed high correlations, r = 0.75, t(27) = 5.98, P < .001, but differed systematically (WLR: VWA, 40 ± 7% and AO, 35 ± 9%; P < .001). Comparable patterns were found for VW and vessel lumen. HY showed significantly lower WLR (AO, 31 ± 8% and VWA, 36 ± 8%) compared with healthy older (AO, 39 ± 9% [P = .012]; VWA, 42 ± 5% [P = .013]). Conclusions Assessment of WLR by VWA showed a good correlation with laborious analysis of the microstructure by high-resolution AO. Measurement of WLR in different age groups indicated good validity. Deviations in VW, vessel lumen, and WLR between AO and VWA can be explained by systematic differences in image scale and resolution. Future studies are needed to investigate the clinical relevance of microvascular WLR assessment by retinal VWA and its prognostic value. Translational Relevance Additional assessment of retinal WLR by use of digital VWA to evaluate microstructural remodeling may prove to be a valuable extension to the current use of retinal vessel diameters as biomarkers of cardiovascular risk.
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Affiliation(s)
- Lukas Streese
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Lukas Y Brawand
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | | | - Peter M Maloca
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Moorfields Eye Hospital, London, UK
| | - Walthard Vilser
- Institute of Biomedical Engineering and Informatics, Technical University of Ilmenau, Ilmenau, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
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Abstract
PURPOSE Retinal microcirculation represents an easily accessible, non-invasive, in-vivo possibility to assess early microvascular changes. In addition to the assessment of functional (e.g. retinal capillary flow, RCF) and retinal arteriolar structural parameters (e.g. wall-to-lumen-ratio, WLR) we now suggest a new parameter reflecting the resistance in small retinal arterioles (RVR). MATERIAL AND METHODS In 45 normotensive (NT) subjects and 123 patients with hypertension stage 1 (HT) we assessed RCF, WLR, arteriolar diameter, lumen diameter and wall cross section area in the retinal circulation by using scanning laser Doppler flowmetry (SLDF). Mean arterial pressure (MAP) was measured immediately before the SLDF measurement and retinal vascular resistance was calculated (RVR = MAP/RCF). In a separate study the test-retest reliability was determined in 6 volunteers from our clinical staff by assessing RVR three times within six weeks. RESULTS The analysis of the volunteers revealed a coefficient of variation for RVR of 7.75 ± 2.11% and Cronbach´s alpha was 0.90. WLR, a marker of vascular remodeling did not differ between NT and HT. In contrast, RCF and inner diameter of the retinal arterioles (ID) were significantly lower (RCF: p = .045 and ID: p = .001) in the HT group than in the NT group and RVR was significantly higher in the HT group than in the NT group (p < .001). In both groups we found no correlation of RVR with age, but a significant correlation of RVR with WLR (NT: r = 0.34, p = .006; HT: r = 0.25, p = .01), indicating that the RVR reflects vascular remodeling in the retinal circulation. CONCLUSION Our data showed an increased retinal vascular resistance in hypertensive patients compared to non-hypertensive patients prior to the occurrence of structural retinal vascular remodeling. The correlation between RVR and WLR indicates that RVR is a reliable, non-invasive and early-sensitive marker of vascular remodeling in early hypertension.
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Affiliation(s)
- Dennis Kannenkeril
- a Department of Nephrology and Hypertension , University Hospital of the University of Erlangen-Nuremberg , Erlangen , Germany
| | - Joanna M Harazny
- a Department of Nephrology and Hypertension , University Hospital of the University of Erlangen-Nuremberg , Erlangen , Germany.,b Department of Pathophysiology , University of Warmia and Mazury , Olsztyn , Poland
| | - Agnes Bosch
- a Department of Nephrology and Hypertension , University Hospital of the University of Erlangen-Nuremberg , Erlangen , Germany
| | - Christian Ott
- a Department of Nephrology and Hypertension , University Hospital of the University of Erlangen-Nuremberg , Erlangen , Germany
| | - Georg Michelson
- c Department of Ophthalmology , University of Erlangen-Nuremberg , Erlangen , Germany
| | - Roland E Schmieder
- a Department of Nephrology and Hypertension , University Hospital of the University of Erlangen-Nuremberg , Erlangen , Germany
| | - Stefanie Friedrich
- a Department of Nephrology and Hypertension , University Hospital of the University of Erlangen-Nuremberg , Erlangen , Germany
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