Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Center, University of Palermo, Palermo, Italy.
Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Section of Ophthalmology, University of Palermo, Palermo, Italy.
J Clin Hypertens (Greenwich). 2020 Feb;22(2):245-253. doi: 10.1111/jch.13777. Epub 2020 Jan 15.
The choroid is the most vascularized structure of the eye and plays a central role in the development of the retinal vascular changes that occur in arterial hypertension. Changes of choroidal thickness (ChT) assessed by optical coherence tomography (OCT) technology could reflect the vascular complications of hypertension. Also, intrarenal hemodynamic damage, associated with endothelial dysfunction, demonstrated to be a good indicator of systemic morphofunctional arterial impairment. The aim of this study is to assess the relationship between ChT and renal hemodynamics in subjects with essential hypertension. Routine laboratory tests, clinical history, and physical examination, including blood pressure assessment, were performed in 90 subjects with essential hypertension. All patients underwent Doppler ultrasonographic evaluation of intra-renal hemodynamics and OCT imaging to assess ChT. When subjects were divided in two groups based on renal resistive index (RRI), group I (RRI ≥ 75% percentile) showed significantly lower values of ChT than group II (RRI < 75% percentile) (P < .001). When divided in two groups based on the ChT median values, patients with lower ChT had significantly higher RRI values than those with ChT above the median values (P < .05). In multivariate model including age, eGFR, and other variables as confounding factors, RRI ≥ 75% was independently associated with ChT. ChT was significantly correlated with renal resistive index in subjects with essential hypertension, confirmed in multivariate analyses. This result could be referred to changes in vascular elastic properties that occur in retinal and intrarenal vascular system probably due to oxidative stress and endothelial dysfunction commonly found in early complications of hypertension.
脉络膜是眼部血管化程度最高的结构，在动脉高血压引起的视网膜血管变化的发展中起着核心作用。光学相干断层扫描（OCT）技术评估的脉络膜厚度（ChT）变化可以反映高血压的血管并发症。此外，与内皮功能障碍相关的肾内血液动力学损害已被证明是全身形态功能动脉损害的良好指标。本研究旨在评估原发性高血压患者脉络膜厚度与肾内血液动力学之间的关系。对 90 例原发性高血压患者进行了常规实验室检查、临床病史和体格检查，包括血压评估。所有患者均接受了多普勒超声评估肾内血液动力学和 OCT 成像以评估 ChT。当根据肾阻力指数（RRI）将患者分为两组时，组 I（RRI≥75%分位数）的 ChT 值明显低于组 II（RRI＜75%分位数）（P＜.001）。当根据 ChT 中位数将患者分为两组时，ChT 值较低的患者的 RRI 值明显高于 ChT 值高于中位数的患者（P＜.05）。在包括年龄、eGFR 和其他变量作为混杂因素的多变量模型中，RRI≥75%与 ChT 独立相关。在原发性高血压患者中，ChT 与肾阻力指数显著相关，多变量分析证实了这一点。这一结果可能与高血压早期并发症中常见的氧化应激和内皮功能障碍引起的视网膜和肾内血管系统血管弹性特性的变化有关。
