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 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.
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Fang-Fei
FF
Wei
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Zhen-Yu
ZY
Zhang
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Lutgarde
L
Thijs
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Wen-Yi
WY
Yang
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Lotte
L
Jacobs
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Nicholas
N
Cauwenberghs
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Yu-Mei
YM
Gu
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Tatiana
T
Kuznetsova
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Karel
K
Allegaert
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Peter
P
Verhamme
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Yan
Y
Li
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands.
Harry A J
HA
Struijker-Boudier
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences (F.-F.W., Z.-Y.Z, L.T., W.-Y.Y, L.J., N.C., Y.-M.G., T.K., J.A.S.), Department of Development and Regeneration (K.A.), Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences (P.V.), University of Leuven, Leuven, Belgium; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L.); and Department of Pharmacology (H.A.J.S.-B.) and R&D Group VitaK (J.A.S.), Maastricht University, Maastricht, The Netherlands. jan.staessen@med.kuleuven.be.
Jan A
JA
Staessen
D000328:Adult; D001160:Arterioles / Q000000981:diagnostic imaging / Q000473:pathology; D001530:Belgium / Q000453:epidemiology; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000592:standards; D003251:Constriction, Pathologic; D061827:Dimensional Measurement Accuracy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D059468:Masked Hypertension / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D020380:Needs Assessment; D012160:Retina / Q000000981:diagnostic imaging; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012171:Retinal Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D059466:White Coat Hypertension / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology
ambulatory blood pressure monitoring; blood pressure; hypertension; microcirculation; population science; retina