Abstract 14644: There is a Parallel Escalation Between Retinal Vascular Alterations and Arterial Stiffness in Essential Hypertension
Introduction: The clinical and prognostic significance of hypertensive retinal changes, an established hypertension-related target organ damage (TOD), remains controversial.
Hypothesis: We asessed the hypothesis that there is a relationship between retinal alterations and arterial stiffness, an index strongly correlated to increased cardiovascular morbidity and mortality.
Methods: Our population consisted of 268 consecutive newly diagnosed, untreated, essential hypertensives (aged=60±13 years, 151 female, office blood pressure=152/90 mmHg), without any history of cardiovascular disease or any other evident comorbidity. Venous blood samples were drawn for determination of metabolic profile and all participants underwent ambulatory blood pressure monitoring (ABPM). All subjects underwent fundoscopy examination and were distributed to five groups according to Sheie's grading system. (Groups A, B, C, D and E, for Sheie's scale 0, I, II, III and IV, respectively). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (c-f PWV) by means of a computerized method (Complior SP).
Results: The five groups (including 39, 87, 99, 35 and 8 subjects respectively) did not differ with regard to age, gender, ABPM parameters and their metabolic profile (fasting glucose, serum lipids, uric acid) as well. However, hypertensives of higher Scheie's category exhibited significantly greater values of c-f PWV (8±1.3, 9.1±1.8, 9.4±2.1, 9.8±2 and 9.9±2.4 m/sec respectively, p=0.005). Notably, there was a statistically significant difference on pulse pressure among groups (53mmHg, 60mmHg, 63mmHg, 65 mmHg and 67, respectively) (p=0.04), another surrogate marker of arterial stiffness. Multivariable regression analysis showed that age, fundus classification and systolic arterial pressure were independent determinants of c-f PWV.
Conclusions: In hypertensive subjects there is a progressive stiffening of the aorta in parallel to the evolution of the fundus lesions according to Scheie's scale. A possible explanation derives from the fact that same pathophysiological processes, like wall remodeling or endothelium impairment occur in small and in large vessels in the setting of essential hypertension.
- © 2010 by American Heart Association, Inc.