Konstantinidis Lazaros, Guex-Crosier Yan
Jules-Gonin Eye Hospital, FAA, University of Lausanne, Switzerland.
Curr Opin Ophthalmol. 2016 Nov;27(6):514-521. doi: 10.1097/ICU.0000000000000307.
Hypertension is the primary risk factor for cardiovascular disease and mortality that consists a major public health issue worldwide. Hypertension triggers a series of pathophysiological ocular modifications affecting significantly the retinal, choroidal, and optic nerve circulations that result in a range of ocular effects.The retina is the only place in the body where microvasculature can be directly inspected, providing valuable information on hypertension related systemic risks.The aim of this review is to provide an update on latest advances regarding the detection and significance of hypertension related eye signs.
It's been shown that measurable retinal microvascular changes may precede progression of systemic microvascular disease.Last years, there are emerging advances in the field retinal imaging and computer software analysis that have enabled the objective and accurate assessment of retinal vascular caliber, while in association with latest epidemiological studies several other retinal vascular features have been recognized, such as vascular length-to-diameter ratio, and wall-to-lumen ratio that may also be associated to hypertension.Additionally, recent genetic studies have provided some insight to vascular pathophysiological processes having correlated new chromosome's loci to hypertensive retinopathy signs.
Assessment of hypertensive retinopathy signs may convey additional prognostic information on the risk of end-organ damage and may alert for urgent systemic management or even preventive systemic therapies. Further development of retinal vascular imaging and computerized system may provide a significant tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.
高血压是心血管疾病和死亡的主要危险因素,是全球范围内的一个重大公共卫生问题。高血压引发一系列病理生理眼部改变,显著影响视网膜、脉络膜和视神经循环,导致一系列眼部效应。视网膜是人体唯一可直接检查微血管的部位,能提供有关高血压相关全身风险的有价值信息。本综述旨在提供有关高血压相关眼部体征检测及意义的最新进展。
已表明可测量的视网膜微血管变化可能先于全身微血管疾病进展。近年来,视网膜成像和计算机软件分析领域有新进展,能够客观准确地评估视网膜血管管径,同时结合最新流行病学研究,还识别出其他一些视网膜血管特征,如血管长度与直径比以及壁腔比,这些也可能与高血压有关。此外,近期基因研究为血管病理生理过程提供了一些见解,将新的染色体位点与高血压性视网膜病变体征相关联。
评估高血压性视网膜病变体征可能传达有关终末器官损害风险的额外预后信息,并可能提醒进行紧急全身管理甚至预防性全身治疗。视网膜血管成像和计算机系统的进一步发展可能为改善临床实践中高血压的诊断、预后和管理提供重要工具。