J Hypertens. 2011 Sep;29(9):1667-75. doi: 10.1097/HJH.0b013e3283496655.
The use of retinal photography in clinical practice and research has substantially increased the knowledge about the epidemiology, natural history and significance of diabetic and hypertensive retinopathy. Early retinopathy signs, including retinal microaneurysms, blot hemorrhages, cotton-wool spots and hard exudates, are common vascular abnormalities found in middle-aged to older people with diabetes and hypertension. The presence of these early retinopathy signs is associated with an increased risk of systemic vascular diseases, such as stroke, cognitive impairment, coronary heart disease, heart failure and nephropathy. These retinopathy lesions may therefore be considered as biomarkers of systemic microvascular processes caused by diabetes and hypertension. Nevertheless, whereas the interest in retinopathy assessment continues to grow, a core concept remains undefined: what is the relative importance and contribution of diabetes and hypertension in the development of early retinopathy signs? The answer of this fundamental question holds the key to better understanding of the systemic associations of early hypertensive and diabetic retinopathy. In this review, we summarize the similarities and differences of early retinopathy signs seen in diabetes and hypertension, and discuss the conceptual relevance from epidemiological, pathophysiological, and clinical perspectives.
视网膜摄影在临床实践和研究中的应用大大提高了我们对糖尿病和高血压性视网膜病变的流行病学、自然史和意义的认识。视网膜微动脉瘤、斑片状出血、棉絮斑和硬性渗出等早期视网膜病变的迹象，在患有糖尿病和高血压的中老年人中很常见，是常见的血管异常。这些早期视网膜病变的迹象与全身性血管疾病（如中风、认知障碍、冠心病、心力衰竭和肾病）的风险增加有关。因此，这些视网膜病变可能被视为糖尿病和高血压引起的系统性微血管病变的生物标志物。尽管对视网膜病变评估的兴趣不断增加，但一个核心概念仍然没有明确定义：糖尿病和高血压在早期视网膜病变的发生中相对重要性和贡献是什么？这个基本问题的答案是更好地理解早期高血压和糖尿病性视网膜病变的系统性关联的关键。在这篇综述中，我们总结了糖尿病和高血压中所见的早期视网膜病变迹象的异同，并从流行病学、病理生理学和临床角度讨论了概念上的相关性。
