Klein R, Klein B E, Moss S E, Wang Q
Department of Ophthalmology, University of Wisconsin-Madison.
Arch Ophthalmol. 1994 Jan;112(1):92-8. doi: 10.1001/archopht.1994.01090130102026.
To investigate the relationship of various retinal lesions to systemic hypertension in the population-based Beaver Dam Eye Study.
In this cross-sectional population-based study, blood pressure was measured using standardized protocols. Using standardized protocols, stereoscopic color fundus photographs were graded in a masked fashion to determine the presence of retinopathy (defined as retinal microaneurysms only, blot hemorrhages only, hemorrhages and/or microaneurysms, cotton-wool spots, hard exudates, intraretinal microvascular abnormalities, venous beading, and retinal new vessels), retinal arteriolar narrowing, and arteriovenous nicking.
Subjects aged 43 through 84 years who lived in Beaver Dam, Wis, between 1987 and 1988 were examined between 1988 and 1990. People with diabetes or retinal vascular occlusions were excluded.
Retinopathy was present in 336 subjects (7.8%), arteriolar narrowing in 582 subjects (13.5%), and arteriovenous nicking in 95 subjects (2.2%) in the nondiabetic population. Hypertension was associated with increased frequency of retinopathy, arteriolar narrowing, and arteriovenous nicking. After adjusting for age, hypertension was associated with the presence of retinopathy (in men: relative risk [RR], 1.47; 95% confidence interval [CI], 1.10 to 1.96; in women: RR, 1.69; 95% CI, 1.26 to 2.27), arteriolar narrowing (in men: RR, 1.34; 95% CI, 1.03 to 1.74; in women: RR, 1.37; 95% CI, 1.14 to 1.64), and arteriovenous nicking (in men: RR, 1.87; 95% CI, 0.99 to 3.54; in women: RR, 1.65; 95% CI, 1.00 to 2.73). Retinopathy, arteriolar narrowing, and arteriovenous nicking were more frequent in those subjects whose blood pressure was elevated despite use of antihypertensive medications compared with those subjects whose blood pressure was controlled with antihypertensive medications or those who were normotensive.
These data suggest that retinopathy and retinal arteriolar narrowing are common in people with hypertension. Further longitudinal study is necessary to evaluate the public health significance of these retinal lesions regarding possibly increased risk of renal and cardiovascular disease.
在基于人群的比弗迪尔姆眼研究中，调查各种视网膜病变与系统性高血压之间的关系。
在这项基于人群的横断面研究中，使用标准化方案测量血压。采用标准化方案，以盲法对立体彩色眼底照片进行分级，以确定是否存在视网膜病变（定义为仅视网膜微动脉瘤、仅点状出血、出血和/或微动脉瘤、棉絮斑、硬性渗出、视网膜内微血管异常、静脉串珠样改变和视网膜新生血管）、视网膜小动脉狭窄和动静脉交叉压迹。
1987年至1988年居住在威斯康星州比弗迪尔姆、年龄在43至84岁之间的受试者于1988年至1990年接受检查。排除患有糖尿病或视网膜血管阻塞的人群。
在非糖尿病人群中，336名受试者（7.8%）存在视网膜病变，582名受试者（13.5%）存在小动脉狭窄，95名受试者（2.2%）存在动静脉交叉压迹。高血压与视网膜病变、小动脉狭窄和动静脉交叉压迹的发生率增加相关。在调整年龄后，高血压与视网膜病变的存在相关（男性：相对危险度[RR]，1.47；95%置信区间[CI]，[1.10, 1.96]；女性：RR，1.69；95% CI，[1.26, 2.27]）、小动脉狭窄（男性：RR，1.34；95% CI，[1.03, 1.74]；女性：RR，1.37；95% CI，[1.14, 1.64]）以及动静脉交叉压迹（男性：RR，1.87；95% CI，[0.99, 3.54]；女性：RR，1.65；95% CI，[1.00, 2.73]）。与血压通过抗高血压药物得到控制的受试者或血压正常的受试者相比，尽管使用了抗高血压药物但血压仍升高的受试者中，视网膜病变、小动脉狭窄和动静脉交叉压迹更为常见。
这些数据表明，视网膜病变和视网膜小动脉狭窄在高血压患者中很常见。有必要进行进一步的纵向研究，以评估这些视网膜病变对于可能增加的肾脏和心血管疾病风险的公共卫生意义。
