Retinal microvascular changes and target organ damage in untreated essential hypertensives

Cesare Cuspidi, Stefano Meani, Maurizio Salerno, Veronica Fusi, Barbara Severgnini, Cristiana Valerio, Eleonora Catini, Arturo Esposito, Fabio Magrini, Alberto Zanchetti

Research output: Contribution to journalArticle

Abstract

Background and purpose: The clinical and prognostic significance of initial retinal alterations in hypertensive patients remains controversial. Therefore, we assessed the relationship of microvascular abnormalities with prognostically validated markers of target organ damage (TOD), such as left ventricular mass (LVM), carotid intimamedia thickness (IMT) and microalbuminuria, in early stages of untreated essential hypertension. Methods: A total of 437 consecutive, never-treated patients with grade 1 or 2 essential hypertension, referred to our outpatient clinic, underwent the following procedures: (1) clinical and routine laboratory examinations, (2) 24-h ambulatory blood pressure monitoring, (3) 24-h urine collection for microalbuminuria, (4) echocardiography, (5) carotid ultrasonography, (6) non-mydriatic retinography. Patients were divided into group I, with either a normal retinal pattern (n = 65, 14.9%) or arteriolar narrowing (n = 185, 42.4%) and group II with arteriovenous crossings (n = 187, 42.70/0). Results: The two groups were similar for gender, body mass index, smoking habit, heart rate, clinic and ambulatory blood pressure (BP) values, while mean age was slightly but significantly higher in group II than in group I (47.6 ± 10.7 versus 44.5 ± 12.5 years, P = 0.008). No differences occurred between the two groups in LVM index (101.8 ± 18.5 versus 99.9 ± 20.4 g/m2), carotid IMT (0.67 ± 0.12 versus 0.66 ± 0.20 mm), urinary albumin excretion rate (14.4 ± 27.7 versus 13.3 ± 27.7 mg/24 h) as well as in the prevalence of LV hypertrophy (14.3 versus 14.0%), IM thickening and/or plaques (26.5 versus 27.2%) (both defined according to 2003 ESH-ESC guidelines) and microalbuminuria (10.1 versus 8.7%). Furthermore, the three different retinal artery patterns were similarly distributed among tertiles of LV mass index, IMT and urinary albumin excretion rate. Conclusions: These results show that: (1) a very large fraction (more than 80%) of untreated, recently diagnosed hypertensive patients have initial retinal microvascular abnormalities detectable by non-mydriatic retinography, (2) the presence of arteriovenous crossings is not associated with more prominent cardiac and extracardiac TOD, (3) fundoscopic examination has a limited clinical value to detect widespread organ involvement in early phases of grade 1 and 2 hypertension.

Original languageEnglish
Pages (from-to)2095-2102
Number of pages8
JournalJournal of Hypertension
Volume22
Issue number11
DOIs
Publication statusPublished - Nov 2004

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Albumins
Retinal Artery
Urine Specimen Collection
Ambulatory Blood Pressure Monitoring
Ambulatory Care Facilities
Hypertrophy
Habits
Echocardiography
Ultrasonography
Body Mass Index
Heart Rate
Smoking
Guidelines
Blood Pressure
Hypertension
Essential Hypertension

Keywords

  • Hypertension
  • Retinal changes
  • Target organ damage

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology

Cite this

Retinal microvascular changes and target organ damage in untreated essential hypertensives. / Cuspidi, Cesare; Meani, Stefano; Salerno, Maurizio; Fusi, Veronica; Severgnini, Barbara; Valerio, Cristiana; Catini, Eleonora; Esposito, Arturo; Magrini, Fabio; Zanchetti, Alberto.

In: Journal of Hypertension, Vol. 22, No. 11, 11.2004, p. 2095-2102.

Research output: Contribution to journalArticle

Cuspidi, C, Meani, S, Salerno, M, Fusi, V, Severgnini, B, Valerio, C, Catini, E, Esposito, A, Magrini, F & Zanchetti, A 2004, 'Retinal microvascular changes and target organ damage in untreated essential hypertensives', Journal of Hypertension, vol. 22, no. 11, pp. 2095-2102. https://doi.org/10.1097/00004872-200411000-00010
Cuspidi, Cesare ; Meani, Stefano ; Salerno, Maurizio ; Fusi, Veronica ; Severgnini, Barbara ; Valerio, Cristiana ; Catini, Eleonora ; Esposito, Arturo ; Magrini, Fabio ; Zanchetti, Alberto. / Retinal microvascular changes and target organ damage in untreated essential hypertensives. In: Journal of Hypertension. 2004 ; Vol. 22, No. 11. pp. 2095-2102.
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abstract = "Background and purpose: The clinical and prognostic significance of initial retinal alterations in hypertensive patients remains controversial. Therefore, we assessed the relationship of microvascular abnormalities with prognostically validated markers of target organ damage (TOD), such as left ventricular mass (LVM), carotid intimamedia thickness (IMT) and microalbuminuria, in early stages of untreated essential hypertension. Methods: A total of 437 consecutive, never-treated patients with grade 1 or 2 essential hypertension, referred to our outpatient clinic, underwent the following procedures: (1) clinical and routine laboratory examinations, (2) 24-h ambulatory blood pressure monitoring, (3) 24-h urine collection for microalbuminuria, (4) echocardiography, (5) carotid ultrasonography, (6) non-mydriatic retinography. Patients were divided into group I, with either a normal retinal pattern (n = 65, 14.9{\%}) or arteriolar narrowing (n = 185, 42.4{\%}) and group II with arteriovenous crossings (n = 187, 42.70/0). Results: The two groups were similar for gender, body mass index, smoking habit, heart rate, clinic and ambulatory blood pressure (BP) values, while mean age was slightly but significantly higher in group II than in group I (47.6 ± 10.7 versus 44.5 ± 12.5 years, P = 0.008). No differences occurred between the two groups in LVM index (101.8 ± 18.5 versus 99.9 ± 20.4 g/m2), carotid IMT (0.67 ± 0.12 versus 0.66 ± 0.20 mm), urinary albumin excretion rate (14.4 ± 27.7 versus 13.3 ± 27.7 mg/24 h) as well as in the prevalence of LV hypertrophy (14.3 versus 14.0{\%}), IM thickening and/or plaques (26.5 versus 27.2{\%}) (both defined according to 2003 ESH-ESC guidelines) and microalbuminuria (10.1 versus 8.7{\%}). Furthermore, the three different retinal artery patterns were similarly distributed among tertiles of LV mass index, IMT and urinary albumin excretion rate. Conclusions: These results show that: (1) a very large fraction (more than 80{\%}) of untreated, recently diagnosed hypertensive patients have initial retinal microvascular abnormalities detectable by non-mydriatic retinography, (2) the presence of arteriovenous crossings is not associated with more prominent cardiac and extracardiac TOD, (3) fundoscopic examination has a limited clinical value to detect widespread organ involvement in early phases of grade 1 and 2 hypertension.",
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AU - Cuspidi, Cesare

AU - Meani, Stefano

AU - Salerno, Maurizio

AU - Fusi, Veronica

AU - Severgnini, Barbara

AU - Valerio, Cristiana

AU - Catini, Eleonora

AU - Esposito, Arturo

AU - Magrini, Fabio

AU - Zanchetti, Alberto

PY - 2004/11

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N2 - Background and purpose: The clinical and prognostic significance of initial retinal alterations in hypertensive patients remains controversial. Therefore, we assessed the relationship of microvascular abnormalities with prognostically validated markers of target organ damage (TOD), such as left ventricular mass (LVM), carotid intimamedia thickness (IMT) and microalbuminuria, in early stages of untreated essential hypertension. Methods: A total of 437 consecutive, never-treated patients with grade 1 or 2 essential hypertension, referred to our outpatient clinic, underwent the following procedures: (1) clinical and routine laboratory examinations, (2) 24-h ambulatory blood pressure monitoring, (3) 24-h urine collection for microalbuminuria, (4) echocardiography, (5) carotid ultrasonography, (6) non-mydriatic retinography. Patients were divided into group I, with either a normal retinal pattern (n = 65, 14.9%) or arteriolar narrowing (n = 185, 42.4%) and group II with arteriovenous crossings (n = 187, 42.70/0). Results: The two groups were similar for gender, body mass index, smoking habit, heart rate, clinic and ambulatory blood pressure (BP) values, while mean age was slightly but significantly higher in group II than in group I (47.6 ± 10.7 versus 44.5 ± 12.5 years, P = 0.008). No differences occurred between the two groups in LVM index (101.8 ± 18.5 versus 99.9 ± 20.4 g/m2), carotid IMT (0.67 ± 0.12 versus 0.66 ± 0.20 mm), urinary albumin excretion rate (14.4 ± 27.7 versus 13.3 ± 27.7 mg/24 h) as well as in the prevalence of LV hypertrophy (14.3 versus 14.0%), IM thickening and/or plaques (26.5 versus 27.2%) (both defined according to 2003 ESH-ESC guidelines) and microalbuminuria (10.1 versus 8.7%). Furthermore, the three different retinal artery patterns were similarly distributed among tertiles of LV mass index, IMT and urinary albumin excretion rate. Conclusions: These results show that: (1) a very large fraction (more than 80%) of untreated, recently diagnosed hypertensive patients have initial retinal microvascular abnormalities detectable by non-mydriatic retinography, (2) the presence of arteriovenous crossings is not associated with more prominent cardiac and extracardiac TOD, (3) fundoscopic examination has a limited clinical value to detect widespread organ involvement in early phases of grade 1 and 2 hypertension.

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