Houben A J, Canoy M C, Paling H A, Derhaag P J, de Leeuw P W
Department of Medicine, University Hospital Maastricht, The Netherlands.
J Hypertens. 1995 Dec;13(12 Pt 2):1729-33.
To describe a quantitative analysis method for retinal vascular changes and to study retinal vascular changes in patients with mild essential or renovascular hypertension in relation to 24-h ambulatory blood pressure monitoring.
A cross-sectional prospective study was performed in 10 patients with essential hypertension and nine with renovascular hypertension selected from the outpatient clinic (continuing medication) compared with eight age-matched normotensive control subjects. Fundal photography was performed in both eyes, preceded or succeeded (in random order) by 24-h ambulatory blood pressure monitoring. The fundus photographs were projected on a glass table and vascular morphometric variables were determined. Vascular density was evaluated using a stereological technique with a square grid overlay. The main outcome measures were arterial and venous diameters near the optic disc and at the first bifurcation, vessel length, angles of bifurcating arteries and veins, and peripheral arteriolar and venular density.
Both the arterial and the venous diameter was larger in the essential hypertensives and the renovascular hypertensives compared with the controls. Vascular diameter was positively correlated with mean arterial pressure during the night and with the night : day mean arterial pressure ratio (a measure of nocturnal blood pressure decline). Venular density was decreased in essential hypertension only and was not correlated with blood pressure.
Our quantitative retinal vascular analysis method detected an increased vascular diameter in both essential and renovascular hypertensives, which was related to night-time blood pressure and, in particular, to an attenuated nocturnal blood pressure decline. Vascular rarefaction in essential hypertension was not related to blood pressure and could influence the pathogenesis of essential hypertension.
描述一种视网膜血管变化的定量分析方法，并研究轻度原发性或肾血管性高血压患者的视网膜血管变化与24小时动态血压监测的关系。
进行一项横断面前瞻性研究，从门诊（持续用药）中选取10例原发性高血压患者和9例肾血管性高血压患者，并与8例年龄匹配的血压正常对照者进行比较。对双眼进行眼底摄影，在其之前或之后（随机顺序）进行24小时动态血压监测。将眼底照片投射到玻璃桌上，测定血管形态计量学变量。使用带有方形网格覆盖物的体视学技术评估血管密度。主要观察指标为视盘附近和第一分支处的动脉和静脉直径、血管长度、分支动脉和静脉的角度以及周边小动脉和小静脉密度。
与对照组相比，原发性高血压患者和肾血管性高血压患者的动脉和静脉直径均更大。血管直径与夜间平均动脉压以及夜间：日间平均动脉压比值（夜间血压下降的一个指标）呈正相关。仅原发性高血压患者的小静脉密度降低，且与血压无关。
我们的定量视网膜血管分析方法检测到原发性高血压和肾血管性高血压患者的血管直径均增加，这与夜间血压有关，尤其是与夜间血压下降减弱有关。原发性高血压中的血管稀疏与血压无关，可能影响原发性高血压的发病机制。
