Paini Anna, Agabiti Rosei Claudia, De Ciuceis Carolina, Aggiusti Carlo, Bertacchini Fabio, Cacciatore Marco, Capellini Sara, Gatta Roberto, Malerba Paolo, Stassaldi Deborah, Rizzoni Damiano, Salvetti Massimo, Muiesan Maria Lorenza
Department of Clinical and Experimental Sciences, University of Brescia & Emergency Medicine ASST Spedali Civili di Brescia, 25121 Brescia, Italy.
Department of Clinical and Experimental Sciences, University of Brescia & 2a Medicina ASST Spedali Civili di Brescia, 25121 Brescia, Italy.
J Clin Med. 2022 Nov 25;11(23):6966. doi: 10.3390/jcm11236966.
Though the relationship between both “attended” and “unattended” BP and several forms of target organ damage have been evaluated, data on retinal arteriolar alterations are lacking. The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and retinal arteriolar changes in consecutive individuals undergoing a clinical evaluation and assessment of retinal fundus at an ESH Excellence Centre. An oscillometric device programmed to perform 3 BP measurements, at 1 min intervals and after 5 min of rest was used on all individuals to measure BP with the patient alone in the room (“unattended”) or in the presence of the physician (“attended”) in the same day in a random order. The retinal arteriole’s wall thickness (WT) was measured automatically by a localization algorithm as the difference between external (ED) and internal diameter (ID) by adaptive optics (RTX-1, Imagine Eyes, Orsay, Francia). Media-to-lumen ratio (WLR) of the retinal arterioles and cross-sectional area (WCSA) of the vascular wall were calculated. Results: One-hundred-forty-two patients were examined (mean age 57 ± 12 yrs, 48% female, mean BMI 26 ± 4). Among them, 60% had hypertension (84% treated) and 11% had type 2 diabetes mellitus. Unattended systolic BP (SBP) was lower as compared to attended SBP (129 ± 14.8. vs. 122.1 ± 13.6 mmHg, p < 0.0001). WLR was similarly correlated with unattended and attended SBP (r = 0.281, p < 0.0001 and r = 0.382, p < 0.0001) and with unattended and attended diastolic BP (r = 0.34, p < 0.001 and r = 0.29, p < 0.0001). The differences between correlations were not statistically significant (Steiger’s Z test). Conclusion: The measurement of “unattended” or “attended” BP provides different values, and unattended BP is lower as compared to attended BP. In this study a similar correlation was observed between attended and unattended BP values and structural changes of retinal arterioles.
尽管已经评估了“就诊时”和“未就诊时”的血压与几种形式的靶器官损害之间的关系，但关于视网膜小动脉改变的数据仍然缺乏。我们研究的目的是评估在一家ESH卓越中心接受临床评估和眼底检查的连续个体中，“就诊时”或“未就诊时”的血压值与视网膜小动脉变化之间的关系。所有个体均使用一台经过编程的示波装置，在休息5分钟后，每隔1分钟进行3次血压测量，以测量血压，测量时患者单独在房间内（“未就诊时”）或在医生在场的情况下（“就诊时”），且测量顺序随机。视网膜小动脉壁厚度（WT）通过一种定位算法自动测量，该算法通过自适应光学技术（RTX-1，Imagine Eyes，法国奥赛）计算外径（ED）和内径（ID）之间的差值。计算视网膜小动脉的中膜与管腔比值（WLR）和血管壁的横截面积（WCSA）。结果：共检查了142例患者（平均年龄57±12岁，48%为女性，平均BMI为26±4）。其中，60%患有高血压（84%接受治疗），11%患有2型糖尿病。未就诊时的收缩压（SBP）低于就诊时的SBP（129±14.8与122.1±13.6 mmHg，p<0.0001）。WLR与未就诊时和就诊时的SBP均呈相似的相关性（r=0.2, p<0.0001和r=0.382, p<0.0001），与未就诊时和就诊时的舒张压也呈相似的相关性（r=0.34, p<0.001和r=0.29, p<0.0001）。相关性之间的差异无统计学意义（Steiger Z检验）。结论：“未就诊时”或“就诊时”的血压测量提供了不同的值，且未就诊时的血压低于就诊时的血压。在本研究中，观察到就诊时和未就诊时的血压值与视网膜小动脉结构变化之间存在相似的相关性。
