Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data.
Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data.
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DOI：
10.1097/hjh.0b013e32836586f4
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发表时间：
2014-02
影响因子：
4.9
通讯作者：
Meta-Eye Study Group
中科院分区：
文献类型：
--
作者：
Ding J;Wai KL;McGeechan K;Ikram MK;Kawasaki R;Xie J;Klein R;Klein BB;Cotch MF;Wang JJ;Mitchell P;Shaw JE;Takamasa K;Sharrett AR;Wong TY;Meta-Eye Study Group
微血管功能障碍已被认为是高血压发生的主要致病因素。我们通过对个体参与者数据的荟萃分析，检查了视网膜血管口径（全身微血管功能障碍的标志物）与高血压事件之间的关联。我们对通过搜索电子数据库、审查参考文献列表以及与专家通信确定的相关研究进行了系统回顾。如果参与者是从一般人群中选择的，在基线时使用计算机辅助方法根据照片测量视网膜血管口径，并对个体进行随访以确定高血压的发病率，则研究就被纳入其中。包括来自六项基于人群的前瞻性队列研究的预先指定的个人记录数据。每项研究均构建了离散时间比例优势模型，并对高血压危险因素进行了调整。使用随机效应荟萃分析汇总每 20 μm 差异的对数比值比 (OR)。在 10,229 名没有患有高血压、糖尿病或心血管疾病的参与者中，2599 名参与者在中位随访期间（2.9 至 10 年）出现新发高血压。较窄的视网膜小动脉[合并多变量调整后的 OR 每 20 μm 差异 1.29，95% 置信区间 (CI) 1.20–1.39] 和较宽的小静脉（OR 每 20 μm 差异 1.14，95% CI 1.06–1.23）均与高血压风险增加相关。基线时小动脉每窄 20 μm，5 年内 SBP 增加 1.12 mmHg (95% CI 0.25–1.99)。视网膜小动脉狭窄和静脉扩张与高血压风险增加独立相关。这些发现强调了微血管重塑在高血压发病机制中的重要性。
Microvascular dysfunction has been suggested to be a major pathogenic factor for the development of hypertension. We examined the association between retinal vascular caliber, a marker of systemic microvascular dysfunction, and incident hypertension on a meta-analysis of individual participant data. We performed a systematic review with relevant studies identified through a search of electronic databases, a review of reference lists, and correspondence with experts. Studies were included if participants were selected from a general population, retinal vascular caliber was measured from photographs using computer-assisted methods at baseline, and individuals were followed up to ascertain the incidence of hypertension. Prespecified individual recorded data from six population-based prospective cohort studies were included. Discrete time proportional odds models were constructed for each study with adjustment for hypertension risk factors. Log odds ratios (ORs) per 20-μm difference were pooled using random-effects meta-analysis. Among 10 229 participants without prevalent hypertension, diabetes, or cardiovascular disease, 2599 developed new-onset hypertension during median follow-up periods ranging from 2.9 to 10 years. Both narrower retinal arterioles [pooled multivariate-adjusted OR per 20-μm difference 1.29, 95% confidence interval (CI) 1.20–1.39] and wider venules (OR per 20-μm difference 1.14, 95% CI 1.06–1.23) were associated with an increased risk of hypertension. Each 20 μm narrower arterioles at baseline were associated with a 1.12 mmHg (95% CI 0.25–1.99) greater increase in SBP over 5 years. Retinal arteriolar narrowing and venular widening were independently associated with an increased risk of hypertension. These findings underscore the importance of microvascular remodeling in the pathogenesis of hypertension.