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Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing

At variance with the long established paradigm that retinal arteriolar narrowing trails hypertension, several longitudinal studies, all based on conventional blood pressure (CBP) measurement, proposed that retinal arteriolar narrowing indicates heightened microvascular resistance and precedes hypert...

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Autores principales: Wei, Fang-Fei, Zhang, Zhen-Yu, Thijs, Lutgarde, Yang, Wen-Yi, Jacobs, Lotte, Cauwenberghs, Nicholas, Gu, Yu-Mei, Kuznetsova, Tatiana, Allegaert, Karel, Verhamme, Peter, Li, Yan, Struijker-Boudier, Harry A.J., Staessen, Jan A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott, Williams & Wilkins 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956676/
https://www.ncbi.nlm.nih.gov/pubmed/27324224
http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.07523
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author Wei, Fang-Fei
Zhang, Zhen-Yu
Thijs, Lutgarde
Yang, Wen-Yi
Jacobs, Lotte
Cauwenberghs, Nicholas
Gu, Yu-Mei
Kuznetsova, Tatiana
Allegaert, Karel
Verhamme, Peter
Li, Yan
Struijker-Boudier, Harry A.J.
Staessen, Jan A.
author_facet Wei, Fang-Fei
Zhang, Zhen-Yu
Thijs, Lutgarde
Yang, Wen-Yi
Jacobs, Lotte
Cauwenberghs, Nicholas
Gu, Yu-Mei
Kuznetsova, Tatiana
Allegaert, Karel
Verhamme, Peter
Li, Yan
Struijker-Boudier, Harry A.J.
Staessen, Jan A.
author_sort Wei, Fang-Fei
collection PubMed
description At variance with the long established paradigm that retinal arteriolar narrowing trails hypertension, several longitudinal studies, all based on conventional blood pressure (CBP) measurement, proposed that retinal arteriolar narrowing indicates heightened microvascular resistance and precedes hypertension. In 783 randomly recruited Flemish (mean age, 38.2 years; 51.3% women), we investigated to what extent CBP and daytime (10 am to 8 pm) ambulatory blood pressure (ABP) measured at baseline (1989–2008) predicted the central retinal arteriolar equivalent (CRAE) in retinal photographs obtained at follow-up (2008–2015). Systolic/diastolic hypertension thresholds were 140/90 mm Hg for CBP and 135/85 mm Hg for ABP. In multivariable-adjusted models including both baseline CBP and ABP, CRAE after 10.3 years (median) of follow-up was unrelated to CBP (P≥0.14), whereas ABP predicted CRAE narrowing (P≤0.011). Per 1-SD increment in systolic/diastolic blood pressure, the association sizes were −0.95 µm (95% confidence interval, −2.20 to 0.30)/−0.75 µm (−1.93 to 0.42) for CBP and −1.76 µm (−2.95 to −0.58)/−1.48 µm (−2.61 to −0.34) for ABP. Patients with ambulatory hypertension at baseline (17.0%) had smaller CRAE (146.5 versus 152.6 µm; P<0.001) at follow-up. CRAE was not different (P≥0.31) between true normotension (normal CBP and ABP; prevalence, 77.6%) and white-coat hypertension (elevated CBP and normal ABP, 5.4%) and between masked hypertension (normal CBP and elevated ABP, 10.2%) and hypertension (elevated CBP and ABP, 6.8%). In conclusion, the paradigm that retinal arteriolar narrowing precedes hypertension can be explained by the limitations of CBP measurement, including nonidentification of masked and white-coat hypertension.
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spelling pubmed-49566762016-08-03 Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing Wei, Fang-Fei Zhang, Zhen-Yu Thijs, Lutgarde Yang, Wen-Yi Jacobs, Lotte Cauwenberghs, Nicholas Gu, Yu-Mei Kuznetsova, Tatiana Allegaert, Karel Verhamme, Peter Li, Yan Struijker-Boudier, Harry A.J. Staessen, Jan A. Hypertension Original Articles At variance with the long established paradigm that retinal arteriolar narrowing trails hypertension, several longitudinal studies, all based on conventional blood pressure (CBP) measurement, proposed that retinal arteriolar narrowing indicates heightened microvascular resistance and precedes hypertension. In 783 randomly recruited Flemish (mean age, 38.2 years; 51.3% women), we investigated to what extent CBP and daytime (10 am to 8 pm) ambulatory blood pressure (ABP) measured at baseline (1989–2008) predicted the central retinal arteriolar equivalent (CRAE) in retinal photographs obtained at follow-up (2008–2015). Systolic/diastolic hypertension thresholds were 140/90 mm Hg for CBP and 135/85 mm Hg for ABP. In multivariable-adjusted models including both baseline CBP and ABP, CRAE after 10.3 years (median) of follow-up was unrelated to CBP (P≥0.14), whereas ABP predicted CRAE narrowing (P≤0.011). Per 1-SD increment in systolic/diastolic blood pressure, the association sizes were −0.95 µm (95% confidence interval, −2.20 to 0.30)/−0.75 µm (−1.93 to 0.42) for CBP and −1.76 µm (−2.95 to −0.58)/−1.48 µm (−2.61 to −0.34) for ABP. Patients with ambulatory hypertension at baseline (17.0%) had smaller CRAE (146.5 versus 152.6 µm; P<0.001) at follow-up. CRAE was not different (P≥0.31) between true normotension (normal CBP and ABP; prevalence, 77.6%) and white-coat hypertension (elevated CBP and normal ABP, 5.4%) and between masked hypertension (normal CBP and elevated ABP, 10.2%) and hypertension (elevated CBP and ABP, 6.8%). In conclusion, the paradigm that retinal arteriolar narrowing precedes hypertension can be explained by the limitations of CBP measurement, including nonidentification of masked and white-coat hypertension. Lippincott, Williams & Wilkins 2016-08 2016-07-13 /pmc/articles/PMC4956676/ /pubmed/27324224 http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.07523 Text en © 2016 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
spellingShingle Original Articles
Wei, Fang-Fei
Zhang, Zhen-Yu
Thijs, Lutgarde
Yang, Wen-Yi
Jacobs, Lotte
Cauwenberghs, Nicholas
Gu, Yu-Mei
Kuznetsova, Tatiana
Allegaert, Karel
Verhamme, Peter
Li, Yan
Struijker-Boudier, Harry A.J.
Staessen, Jan A.
Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing
title Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing
title_full Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing
title_fullStr Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing
title_full_unstemmed Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing
title_short Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing
title_sort conventional and ambulatory blood pressure as predictors of retinal arteriolar narrowing
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956676/
https://www.ncbi.nlm.nih.gov/pubmed/27324224
http://dx.doi.org/10.1161/HYPERTENSIONAHA.116.07523
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