Klein R, Klein B E, Moss S E
University of Wisconsin Medical School, Department of Ophthalmology and Visual Sciences, Madison, USA.
Trans Am Ophthalmol Soc. 1997;95:329-48; discussion 348-50.
The objective was to investigate the relationship of systemic hypertension to the incidence of various retinal vascular lesions in the population-based Beaver Dam Eye Study.
Subjects aged 43 through 86 years who lived in Beaver Dam, Wisconsin between 1987 and 1988 were examined between 1988 and 1990 and 5 years later, 1993-1995. Blood pressure was measured using standardized protocols. Stereoscopic color fundus photographs were graded in a masked fashion using standardized protocols to determine the presence of retinopathy (blot hemorrhages, microaneurysms, hard and soft exudates, intraretinal microvascular abnormalities, and venous beading), retinal arteriolar narrowing, and arterio-venous nicking. People with diabetes or retinal vascular occlusions were excluded from the analyses.
Among those examined, 2,151 (69.1%) were normotensive and 963 (30.9%) were hypertensive at baseline. Over the five-year period, retinopathy developed in 175 (6.0%), arteriolar narrowing in 282 (9.9%) and arterio-venous nicking in 201 (6.5%) nondiabetic subjects. After adjusting for age, hypertension was associated with the incidence of retinopathy (in men: relative risk [RR] 2.31, 95% confidence interval [CI] 1.54 to 3.48; in women: RR 1.61, 95% CI 1.07 to 2.43) and with arteriolar narrowing (in men: RR 1.82, 95% CI 1.25 to 2.66; in women: RR 1.36, 95% CI 1.05 to 1.77), but not with arterio-venous nicking (in men: RR 1.01, 95% CI 0.69 to 1.48; in women: RR 1.37, 95% CI 0.95 to 1.97). The five-year incidence of retinopathy and of arteriolar narrowing was higher 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 show a relation of hypertension to an increased incidence of retinopathy and arteriolar narrowing. Furthermore, these data suggest that pharmacologic control of blood pressure is related to a lower incidence of these anatomic retinal lesions relative to uncontrolled blood pressure.
在基于人群的比弗迪尔姆眼病研究中，研究全身性高血压与各种视网膜血管病变发生率之间的关系。
1987年至1988年居住在威斯康星州比弗迪尔姆、年龄在43岁至86岁之间的受试者于1988年至1990年接受检查，并于5年后（1993年至1995年）再次接受检查。使用标准化方案测量血压。立体彩色眼底照片采用盲法、依据标准化方案进行分级，以确定是否存在视网膜病变（点状出血、微动脉瘤、硬性和软性渗出物、视网膜内微血管异常以及静脉串珠样改变）、视网膜小动脉狭窄和动静脉交叉压迹。患有糖尿病或视网膜血管阻塞的患者被排除在分析之外。
在接受检查的人群中，2151人（69.1%）在基线时血压正常，963人（30.9%）患有高血压。在这五年期间，175名（6.0%）非糖尿病受试者出现视网膜病变，282名（9.9%）出现小动脉狭窄，201名（6.5%）出现动静脉交叉压迹。在对年龄进行校正后，高血压与视网膜病变的发生率相关（男性：相对风险[RR]2.31，95%置信区间[CI]1.54至3.48；女性：RR 1.61，95%CI 1.07至2.43），也与小动脉狭窄相关（男性：RR 1.82，95%CI 1.25至2.66；女性：RR 1.36，95%CI 1.05至1.77），但与动静脉交叉压迹无关（男性：RR 1.01，95%CI 0.69至1.48；女性：RR 1.37，95%CI 0.
