Wong Tien Yin, Klein Ronald, Sharrett A Richey, Duncan Bruce B, Couper David J, Klein Barbara E K, Hubbard Larry D, Nieto F Javier
Centre for Eye Research Australia, University of Melbourne, East Melbourne Victoria, Australia.
Ann Intern Med. 2004 Feb 17;140(4):248-55. doi: 10.7326/0003-4819-140-4-200402170-00006.
Narrowing of the small arterioles has been hypothesized to contribute to the pathogenesis of hypertension, but prospective clinical data are lacking.
To examine the relation of retinal arteriolar narrowing to incident hypertension in healthy middle-aged persons.
Prospective cohort study.
The population-based Atherosclerosis Risk in Communities Study, conducted in 4 U.S. communities.
5628 persons 49 to 73 years of age without preexisting hypertension.
Diameters of retinal vessels were measured from digitized retinal photographs. A summary arteriole-to-venule ratio was computed as an indicator of generalized arteriolar narrowing; a lower ratio indicated greater narrowing. Areas of focal arteriolar narrowing were defined from photographs by using a standard protocol. Incident hypertension, defined as systolic blood pressure of 140 mm Hg or higher, diastolic blood pressure of 90 mm Hg or higher, or use of antihypertensive medication, was identified from the cohort.
After 3 years of follow-up, 811 (14.4%) persons had developed hypertension. The incidence of hypertension was higher in persons with lower arteriole-to-venule ratios (incidence of 8.9%, 12.3%, 13.7%, 14.3%, and 22.3%, comparing decreasing quintiles of the ratio) and in persons with focal arteriolar narrowing than in those without focal arteriolar narrowing (25.1% vs. 13.0%). After the authors controlled for the average systolic and diastolic blood pressures over the preceding 6 years, body mass index, waist-to-hip ratio, and other risk factors, the odds of developing hypertension were approximately 60% higher in persons with lower arteriole-to-venule ratios (odds ratio, 1.62 [95% CI, 1.21 to 2.18] comparing lowest to highest quintile; P = 0.006 for trend) and focal arteriolar narrowing (odds ratio, 1.61 [CI, 1.27 to 2.04]; P < 0.001).
Smaller retinal arteriolar diameters are independently associated with incident hypertension, which suggests that arteriolar narrowing may be linked to the occurrence and development of hypertension.
小动脉狭窄被认为与高血压的发病机制有关，但缺乏前瞻性临床数据。
研究健康中年人群视网膜小动脉狭窄与新发高血压之间的关系。
前瞻性队列研究。
在美国4个社区开展的基于人群的社区动脉粥样硬化风险研究。
5628名年龄在49至73岁之间且无高血压病史的人。
从数字化视网膜照片中测量视网膜血管直径。计算小动脉与小静脉的汇总比值作为全身性小动脉狭窄的指标；比值越低表明狭窄越严重。使用标准方案从照片中确定局灶性小动脉狭窄区域。从队列中确定新发高血压，定义为收缩压140 mmHg或更高、舒张压90 mmHg或更高，或使用抗高血压药物。
经过3年随访，811人（14.4%）患高血压。小动脉与小静脉比值较低的人群（比值递减的五分位数组的发病率分别为8.9%、12.3%、13.7%、14.3%和22.3%）以及有局灶性小动脉狭窄的人群高血压发病率高于无局灶性小动脉狭窄的人群（25.1%对13.0%）。在作者控制了前6年的平均收缩压和舒张压、体重指数、腰臀比及其他危险因素后，小动脉与小静脉比值较低的人群（最低与最高五分位数组相比，比值比为1.62[95%CI，1.21至2.18]；趋势P = 0.006）和有局灶性小动脉狭窄的人群（比值比为1.61[CI，1.27至2.04]；P < 0.001）患高血压的几率大约高60%。
较小的视网膜小动脉直径与新发高血压独立相关，这表明小动脉狭窄可能与高血压的发生和发展有关。
