Masaidi Meilikemu, Cuspidi Cesare, Giudici Valentina, Negri Francesca, Sala Carla, Zanchetti Alberto, Grassi Guido, Mancia Giuseppe
Istituto di Medicina Cardiovascolare, Fondazione IRCCS Policlinico, Milan, Italy.
J Hypertens. 2009 Jun;27(6):1277-83. doi: 10.1097/HJH.0b013e32832a4012.
Whether retinal microvascular disease is associated with markers of cardiac and extracardiac organ damage in human hypertension is still unclear. We examined the relationship between retinal arteriolar-venular ratio (AVR) and left ventricular hypertrophy, carotid atherosclerosis and microalbuminuria in essential hypertension.
A total of 386 untreated and treated uncomplicated essential hypertensive individuals (mean age 56 +/- 13 years) consecutively attending our hospital outpatient hypertension clinic were considered for the analysis. All individuals underwent extensive clinical and laboratory investigations, including retinal AVR evaluation by a fully automated computer-assisted method, echocardiography and carotid ultrasonography.
Mean retinal AVR was 0.790 +/- 0.079 (range 0.530-0.990). In univariate analyses, AVR showed a significant inverse association with left ventricular mass index (r = -0.15, P = 0.002) and carotid intima-media thickness (IMT) (r = -0.12, P = 0.02); no relationship with microalbuminuria was found. Overall, left ventricular mass index and carotid IMT as well as microalbuminuria, either as continuous or categorical variables, did not show significant differences across AVR quartiles. Moreover, a multivariate analysis failed to demonstrate independent correlations of carotid IMT and left ventricular mass index (P = 0.06 for both) with AVR. Finally, when patients were categorized according to the presence or absence of organ damage, with or without left ventricular hypertrophy (0.783 +/- 0.077 vs. 0.795 +/- 0.081), carotid plaques (0.789 +/- 0.079 vs. 0.791 +/- 0.079), carotid IMT (0.791 +/- 0.077 vs. 0.788 +/- 0.082) or microalbuminuria (0.791 +/- 0.080 vs. 0.777 +/- 0.073), no significant intergroup differences in AVR values were found.
Our findings provide further evidence that retinal AVR is of limited value in identifying hypertensive patients at high cardiovascular risk related to cardiac and extracardiac organ damage.
视网膜微血管疾病是否与人类高血压中心脏及心外器官损伤标志物相关仍不明确。我们研究了原发性高血压患者视网膜动静脉比（AVR）与左心室肥厚、颈动脉粥样硬化及微量白蛋白尿之间的关系。
连续纳入我院门诊高血压诊所的386例未经治疗及治疗后病情未复杂的原发性高血压患者（平均年龄56±13岁）进行分析。所有患者均接受了广泛的临床和实验室检查，包括通过全自动计算机辅助方法评估视网膜AVR、超声心动图及颈动脉超声检查。
视网膜平均AVR为0.790±0.079（范围0.530 - 0.990）。单因素分析中，AVR与左心室质量指数（r = -0.15，P = 0.002）及颈动脉内膜中层厚度（IMT）（r = -0.12，P = 0.02）呈显著负相关；未发现与微量白蛋白尿有关联。总体而言，无论作为连续变量还是分类变量，左心室质量指数、颈动脉IMT以及微量白蛋白尿在AVR四分位数间均未显示出显著差异。此外，多因素分析未能证明颈动脉IMT及左心室质量指数（两者P均 = 0.06）与AVR存在独立相关性。最后，当根据是否存在器官损伤对患者进行分类时，无论有无左心室肥厚（0.783±0.077对0.795±0.081）、颈动脉斑块（0.789±0.079对0.791±0.079）、颈动脉IMT（0.791±0.077对0.788±0.082）或微量白蛋白尿（0.791±0.080对0.777±0.073），AVR值在组间均未发现显著差异。
我们的研究结果进一步证明，视网膜AVR在识别与心脏及心外器官损伤相关的高心血管风险高血压患者方面价值有限。
