title: Central pulse pressure is an independent determinant of vascular remodeling in the retinal circulation.
abstract: Pulse pressure has been recognized as a risk factor for stroke. Moreover, it was shown that central pulse pressure relates more strongly to vascular disease and outcome than (peripheral) brachial pulse pressure. Because vascular remodeling in the retinal circulation mirrors the 1 in the cerebral circulation and represents an easy, noninvasive possibility to assess microvascular changes in humans, we analyzed the impact of central pulse pressure on retinal vascular structure in humans. The study cohort comprised 135 nondiabetic patients across a wide range of blood pressure values. Parameter of retinal arteriolar remodeling (wall-to-lumen ratio) was assessed noninvasively and in vivo by scanning laser Doppler flowmetry. Central pulse pressure and augmentation index normalized to a heart rate of 75 beats per minute were assessed by pulse wave analysis. Central pulse pressure correlated with wall-to-lumen ratio (r=0.302; P<0.001), central augmentation index normalized to a heart rate of 75 beats per minute correlated with wall-to-lumen ratio (r=0.190; P=0.028), and in accordance pulse pressure amplification (peripheral pulse pressure/central pulse pressure) was negatively correlated with wall-to-lumen ratio (r=-0.223; P=0.009). In contrast, central mean arterial pressure was not correlated with wall-to-lumen ratio (r=0.110; P=0.203). Multiple regression analysis revealed an independent relationship between wall-to-lumen ratio and central pulse pressure (β=0.277; P=0.009), but not with other classical cardiovascular risk factors. Thus, central pulse pressure, indicative of changes in large conduit arteries is an independent determinant of vascular remodeling in small retinal arterioles. Such a relationship indicates a coupling and crosstalk between the microvascular and macrovascular changes attributable to hypertension.
authors.affiliation: Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ott
authors.forename: Ulrike
authors.initials: U
authors.lastname: Raff
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Harazny
authors.forename: Georg
authors.initials: G
authors.lastname: Michelson
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology*; D012171:Retinal Vessels / Q000503:physiopathology*; D012307:Risk Factors; D014655:Vascular Resistance / Q000502:physiology*; D055815:Young Adult
keywords: arterioles; augmentation index; central pulse pressure; retinal circulation; wall-to-lumen ratio