Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.
Hypertension. 2013 Jun;61(6):1340-5. doi: 10.1161/HYPERTENSIONAHA.111.00617. Epub 2013 Apr 8.
Pulse pressure has been recognized as a risk factor for stroke. Moreover, it was shown that central pulse pressure relates more strongly to vascular disease and outcome than (peripheral) brachial pulse pressure. Because vascular remodeling in the retinal circulation mirrors the 1 in the cerebral circulation and represents an easy, noninvasive possibility to assess microvascular changes in humans, we analyzed the impact of central pulse pressure on retinal vascular structure in humans. The study cohort comprised 135 nondiabetic patients across a wide range of blood pressure values. Parameter of retinal arteriolar remodeling (wall-to-lumen ratio) was assessed noninvasively and in vivo by scanning laser Doppler flowmetry. Central pulse pressure and augmentation index normalized to a heart rate of 75 beats per minute were assessed by pulse wave analysis. Central pulse pressure correlated with wall-to-lumen ratio (r=0.302; P<0.001), central augmentation index normalized to a heart rate of 75 beats per minute correlated with wall-to-lumen ratio (r=0.190; P=0.028), and in accordance pulse pressure amplification (peripheral pulse pressure/central pulse pressure) was negatively correlated with wall-to-lumen ratio (r=-0.223; P=0.009). In contrast, central mean arterial pressure was not correlated with wall-to-lumen ratio (r=0.110; P=0.203). Multiple regression analysis revealed an independent relationship between wall-to-lumen ratio and central pulse pressure (β=0.277; P=0.009), but not with other classical cardiovascular risk factors. Thus, central pulse pressure, indicative of changes in large conduit arteries is an independent determinant of vascular remodeling in small retinal arterioles. Such a relationship indicates a coupling and crosstalk between the microvascular and macrovascular changes attributable to hypertension.
脉压已被认为是中风的一个危险因素。此外，研究表明，中心脉压与血管疾病和预后的相关性比（外周）肱动脉脉压更强。由于视网膜循环中的血管重构与脑循环中的血管重构相似，并且代表了评估人类微血管变化的一种简单、无创的可能性，因此我们分析了中心脉压对人类视网膜血管结构的影响。该研究队列包括 135 名血压值广泛的非糖尿病患者。通过扫描激光多普勒血流仪无创、体内评估视网膜小动脉重构的参数（壁腔比）。通过脉搏波分析评估中心脉压和校正至心率为 75 次/分钟的增强指数。中心脉压与壁腔比呈正相关（r=0.302；P<0.001），校正至心率为 75 次/分钟的中心增强指数与壁腔比呈正相关（r=0.190；P=0.028），并且与脉搏压放大（外周脉压/中心脉压）呈负相关（r=-0.223；P=0.009）。相反，中心平均动脉压与壁腔比无相关性（r=0.110；P=0.203）。多元回归分析显示，壁腔比与中心脉压之间存在独立关系（β=0.277；P=0.009），但与其他经典心血管危险因素无关。因此，代表大动脉变化的中心脉压是小视网膜小动脉血管重构的独立决定因素。这种关系表明高血压引起的微血管和大血管变化之间存在耦合和串扰。
