年龄、血压及降压治疗对通过自适应光学评估的视网膜小动脉重塑的影响

Effects of age, blood pressure and antihypertensive treatments on retinal arterioles remodeling assessed by adaptive optics.

作者信息

Rosenbaum David, Mattina Alessandro, Koch Edouard, Rossant Florence, Gallo Antonio, Kachenoura Nadjia, Paques Michel, Redheuil Alban, Girerd Xavier

机构信息

aPreventive Cardiovascular Unit, Institute of Cardiometabolism and Nutrition, Groupe Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris bSorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'imagerie Biomédicale cImaging Core Lab, Institute of Cardiometabolism and Nutrition, ICAN dUnité INSERM 968 Institut de la vision, Centre d'Investigation Clinique 503 Centre Hospitalier National des Quinze-Vingts, Assistance Publique-Hôpitaux de Paris eISEP fDépartement d'imagerie cardiovasculaire et de radiologie interventionnelle, Pôle Imagerie-Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.

出版信息

J Hypertens. 2016 Jun;34(6):1115-22. doi: 10.1097/HJH.0000000000000894.

DOI:10.1097/HJH.0000000000000894

PMID:27065002

Abstract

BACKGROUND

In humans, adaptive optics camera enables precise large-scale noninvasive retinal microcirculation evaluation to assess ageing, blood pressure and antihypertensive treatments respective roles on retinal arterioles anatomy.

METHOD

We used adaptive optics camera rtx1 (Imagine-Eyes, Orsay, France) to measure wall thickness, internal diameter and to calculate wall-to-lumen ratio (WLR) and wall cross-sectional area of retinal arterioles. This assessment was repeated within a short period in two subgroups of hypertensive individuals without or with a drug-induced blood pressure drop.

RESULTS

In 1000 individuals, mean wall thickness, lumen diameter and WLR were 23.2 ± 3.9, 78.0 ± 10.9 and 0.300 ± 0.054 μm, respectively. Blood pressure and age both independently increased WLR by thickening arterial wall. In opposite, hypertension narrowed lumen in younger as compared to older individuals (73.2 ± 9.0 vs. 81.7 ± 10.2 μm; P < 0.001), whereas age exerted no influence on lumen diameter. Short-term blood pressure drop (-29.3 ± 17.3/-14.4 ± 10.0 mmHg) induced a WLR decrease (-6.0 ± 8.0%) because of lumen dilatation (+4.4 ± 5.9%) without wall thickness changes. By contrast, no modifications were observed in individuals with stable blood pressure. In treated and controlled hypertensives under monotherapy WLR normalization was observed because of combined wall decrease and lumen dilatation independently of antihypertensive pharmacological classes. In multivariate analysis, hypertension drug regimen was not an independent predictor of any retinal anatomical indices. Retinal arteriolar remodeling comprised blood pressure and age-driven wall thickening as well as blood pressure-triggered lumen narrowing in younger individuals.

CONCLUSION

Remodeling reversal observed in controlled hypertensives seems to include short-term functional and long-term structural changes.

摘要

背景

在人类中，自适应光学相机能够进行精确的大规模无创视网膜微循环评估，以评估衰老、血压和抗高血压治疗对视网膜小动脉解剖结构的各自作用。

方法

我们使用自适应光学相机rtx1（法国奥赛的Imagine-Eyes公司）测量视网膜小动脉的壁厚、内径，并计算壁腔比（WLR）和壁横截面积。在短时间内，对无药物诱导血压下降或有药物诱导血压下降的高血压个体的两个亚组重复进行了这项评估。

结果

在1000名个体中，平均壁厚、管腔直径和WLR分别为23.2±3.9、78.0±10.9和0.300±0.054μm。血压和年龄均通过增厚动脉壁独立增加WLR。相反，与老年个体相比，高血压使年轻个体的管腔变窄（73.2±9.0 vs. 81.7±10.2μm；P<0.001），而年龄对管腔直径没有影响。短期血压下降（-29.3±17.3/-14.4±10.0 mmHg）导致WLR下降（-6.0±8.0%），这是由于管腔扩张（+4.4±5.9%）而壁厚无变化。相比之下，血压稳定的个体未观察到变化。在接受单一疗法治疗和对照的高血压患者中，由于壁减少和管腔扩张的共同作用，无论抗高血压药物类别如何，均观察到WLR正常化。在多变量分析中，高血压药物治疗方案不是任何视网膜解剖指标的独立预测因素。视网膜小动脉重塑包括血压和年龄驱动的壁增厚以及血压引发的年轻个体管腔狭窄。