Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore.
J Hypertens. 2009 Nov;27(11):2209-17. doi: 10.1097/HJH.0b013e328330141d.
Retinal arteriolar narrowing is a marker of chronic microvascular damage from hypertension. We hypothesized that the presence of retinal arteriolar narrowing increases the likelihood of chronic kidney disease (CKD) associated with hypertension.
We examined 3602 persons of Chinese, Malay and Indian ethnicities, aged at least 24 years residing in Singapore. CKD was defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m(2). Hypertension was defined as SBP of at least 140 mmHg or DBP of at least 90 mmHg or self-reported physician-diagnosed hypertension. Retinal arteriolar caliber was measured from retinal photographs and summarized. The lowest arteriolar caliber quartile was defined as retinal arteriolar narrowing.
Both hypertension and retinal arteriolar narrowing were associated with CKD (n = 185), independent of major confounders, with multivariable odds ratio of 2.10 (95% confidence interval 1.46-3.02) for CKD associated with hypertension and odds ratio of 1.68 (95% confidence interval 1.04-2.71) for retinal arteriolar narrowing. The association between hypertension and CKD was stronger in the presence of retinal arteriolar narrowing (P for interaction 0.09), and joint exposure to both hypertension and retinal arteriolar narrowing was associated with a three-fold odds of having CKD (multivariable odds ratio 3.61, 95% confidence interval 1.88-6.93) compared with absence of hypertension and arteriolar caliber in the highest quartile (quartile 4).
These findings show that the presence of microvascular disease in the retina increases the likelihood of CKD associated with hypertension and suggest that examination of the retinal vasculature may aid in stratification of CKD risk in hypertensive patients.
视网膜小动脉狭窄是高血压引起慢性微血管损伤的标志。我们假设视网膜小动脉狭窄的存在增加了与高血压相关的慢性肾脏病（CKD）的可能性。
我们检查了居住在新加坡的 3602 名华人、马来人和印度人，年龄至少 24 岁。CKD 的定义为估计肾小球滤过率（eGFR）<60 ml/min/1.73 m2。高血压定义为收缩压（SBP）≥140 mmHg 或舒张压（DBP）≥90 mmHg 或经医生诊断的高血压。从视网膜照片中测量视网膜小动脉的口径并进行总结。最小的小动脉口径四分位数定义为视网膜小动脉狭窄。
无论是否存在主要混杂因素，高血压和视网膜小动脉狭窄均与 CKD（n = 185）相关，与高血压相关的 CKD 的多变量比值比为 2.10（95%置信区间 1.46-3.02），视网膜小动脉狭窄的比值比为 1.68（95%置信区间 1.04-2.71）。在存在视网膜小动脉狭窄的情况下，高血压与 CKD 之间的相关性更强（交互检验 P 值为 0.09），与高血压和视网膜小动脉狭窄同时存在相比，无高血压和最高四分位数（四分位数 4）的小动脉口径，发生 CKD 的可能性增加三倍（多变量比值比 3.61，95%置信区间 1.88-6.93）。
这些发现表明，视网膜微血管疾病的存在增加了与高血压相关的 CKD 的可能性，并表明检查视网膜血管可能有助于分层高血压患者的 CKD 风险。
