Differential Effects of Antihypertensive Treatment on the Retinal Microcirculation

Thom, Simon; Stettler, Christoph; Stanton, Alice; Witt, Nicholas; Tapp, Robyn J.; Chaturvedi, Nish; Allemann, Sabin; Mayet, Jamil; Sever, Peter; Poulter, Neil; O’Brien, Eoin; Hughes, Alun D.

doi:10.1161/hypertensionaha.109.133819

Cited by 53 publications

(41 citation statements)

References 21 publications

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“…Lundberg et al have reported that following focal/grid laser treatment of DMO, the macular arteriole and venule diameters decreased [103], and Wickremasinghe et al reported a significant narrowing effect on both retinal arteriolar and venular calibres in patients with DMO in response to intravitreal triamcinolone [104]. Studies have also demonstrated regression of retinal vascular changes in response to blood pressure reduction and that regression differs between different antihypertensive regimens [105][106][107].…”

Section: Retinal Vasculature Measurements In Clinical Practicementioning

confidence: 99%

The clinical implications of recent studies on the structure and function of the retinal microvasculature in diabetes

et al. 2015

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The retinal blood vessels provide the opportunity to study early structural and functional changes in the microvasculature prior to clinically significant microvascular and macrovascular complications of diabetes. Advances in digital retinal photography and computerised assessment of the retinal vasculature have provided more objective and precise measurements of retinal vascular changes. Clinic-and population-based studies have reported that these quantitatively measured retinal vascular changes (e.g. retinal arteriolar narrowing and venular widening) are associated with preclinical structural changes in other microvascular systems (e.g. infarct in the cerebral microcirculation), as well as diabetes and diabetic complications, suggesting that they are markers of early microvascular dysfunction. In addition, there are new retinal imaging techniques to further assess alterations in retinal vascular function (e.g. flicker-induced vasodilatory response, blood flow and oxygen saturation) in diabetes and complications that result from the effects of chronic hyperglycaemia, inflammation and endothelial dysfunction.In this review, we summarise the latest findings on the relationships between quantitatively measured structural and functional retinal vascular changes with diabetes and diabetic complications. We also discuss clinical implications and future research to evaluate whether detection of retinal vascular changes has additional value beyond that achieved with methods currently used to stratify the risk of diabetes and its complications.

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Section: Retinal Vasculature Measurements In Clinical Practicementioning

confidence: 99%

The clinical implications of recent studies on the structure and function of the retinal microvasculature in diabetes

et al. 2015

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“…Studies have demonstrated regression of hypertensive retinopathy signs in response to BP reduction and that regression is different in response to different antihypertensive regimens (eg, angiotensin-converting enzyme inhibitors seem to have a more favorable effect on the retinal vasculature). [109][110][111] Changes in retinal vasculature, markers of hypertensive state, may act as therapeutic targets capable of reflecting the effectiveness of antihypertensive drug treatment in controlling elevated BP values. Nevertheless, data describing the impact of antihypertensive therapy on retinal vascular changes are still lacking.…”

Section: Can Retinal Vascular Imaging Be a Surrogate Measure To Evalumentioning

confidence: 99%

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

Cheung

Ikram²,

Sabanayagam³

et al. 2012

Hypertension

222

166

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The retinal vasculature allows direct noninvasive visualization of the body’s mircrovasculature. Because the retina and other end organs (brain and kidney) share similar anatomical features and physiological properties, the retinal vessels offer a unique and easily accessible window to study the health and disease of the human microcirculation. Advanced retinal vascular imaging technologies have been developed to allow a more objective and precise assessment of retinal vascular changes. The changes in the retinal vasculature associated with hypertension can be broadly divided into 3 groups: (1) classic retinal vascular changes in response to blood pressure (referred to as hypertensive retinopathy signs), (2) changes in retinal vascular caliber, and (3) changes in more global geometrical patterns of the retina. In this review, we summarize the current understanding of the relationship between retinal vascular changes and blood pressure, the evidence for the retinal vasculature as a biological model to study the manifestation and early pathogenic correlates of hypertension, the latest advances in retinal vascular imaging technologies, and the future opportunities and challenges of retinal vascular imaging. We suggest that further development of retinal vascular analyses and standardized measurement protocols, evaluation of the clinical use of retinal vascular imaging in assessing cardiovascular risk prediction, and using retinal vascular imaging to test antihypertensive treatments will allow the translation of retinal vascular imaging as a tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.

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“…68 Nevertheless, in comparison with bblockers, the calcium antagonists show better remodeling response in retinal microvasculature attributed to its vasodilatory action. 69 Finally, a retinal assessment may be useful to screen for patients with white-coat hypertension or masked hypertension. These patients are reported to represent How does hypertension affect your eyes?…”

Section: Genetic Associationsmentioning

confidence: 99%

How does hypertension affect your eyes?

2011

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Hypertension has profound effects on various parts of the eye. Classically, elevated blood pressure results in a series of retinal microvascular changes called hypertensive retinopathy, comprising of generalized and focal retinal arteriolar narrowing, arteriovenous nicking, retinal hemorrhages, microaneurysms and, in severe cases, optic disc and macular edema. Studies have shown that mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population. Hypertensive retinopathy signs are associated with other indicators of end-organ damage (for example, left ventricular hypertrophy, renal impairment) and may be a risk marker of future clinical events, such as stroke, congestive heart failure and cardiovascular mortality. Furthermore, hypertension is one of the major risk factors for development and progression of diabetic retinopathy, and control of blood pressure has been shown in large clinical trials to prevent visual loss from diabetic retinopathy. In addition, several retinal diseases such as retinal vascular occlusion (artery and vein occlusion), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration may also be related to hypertension; however, there is as yet no evidence that treatment of hypertension prevents vision loss from these conditions. In management of patients with hypertension, physicians should be aware of the full spectrum of the relationship of blood pressure and the eye.

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Differential Effects of Antihypertensive Treatment on the Retinal Microcirculation

Cited by 53 publications

References 21 publications

The clinical implications of recent studies on the structure and function of the retinal microvasculature in diabetes

The clinical implications of recent studies on the structure and function of the retinal microvasculature in diabetes

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

How does hypertension affect your eyes?

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