血压波动及时间趋势与视网膜血管管径的相关性

目的：探讨高血压人群和非高血压人群中血压波动及时间趋势与视网膜血管管径的相关关系。方法：前瞻性设计，纳入在广州市干部疗养院/广州市第十一人民医院体检的年龄40 岁及以上、无严重心脑血管疾患的公务员。从2008年至2012年，对研究对象进行每年一次的血压监测随访。2012年，采集研究对象眼底照片，采用有效的眼底血管分析方法（IVAN软件）测定视网膜动静脉管径。采用多重线性回归模型分析血压时间趋势及波动与视网膜血管管径的相关关系。结果：共纳入3 419 名个体，其中，高血压个体1 428名，非高血压个体1 991名。多重线性回归分析发现，在高血压人群，独立于基线血压水平和其他传统的心脑血管危险因素，收缩压和舒张压的逐年上升趋势与视网膜动脉（收缩压趋势：β=-0.53，P < 0.001；舒张压趋势：β=-0.63，P =0.006）及静脉（收缩压趋势：β=-0.49，P =0.006；舒张压趋势：β=-0.73，P =0.008）的狭窄相关。在非高血压人群中，血压时间趋势及波动与视网膜血管管径均无相关关系。结论： 血压的逐年上升趋势与高血压人群视网膜动脉和静脉的狭窄相关。血压逐年上升的时间趋势可能是独立于平均血压水平之外的新的血管健康因素。

Association between the Caliber of retinal microvessels and long-Term blood pressure trends and Variability

Objective: To investigate the association between the caliber of retinal microvessels and the long-term blood pressure trend and variability in people with or without hypertension. Methods: A prospective study was conducted in a cohort (n=4 675) of Chinese subjects aged ≥40 years (age range, 40-84 years) in Guangzhou No.11 People's Hospital. Blood pressure was measured annually from 2008 to 2012. In 2012,retinal vascular calibers were assessed based on standard fundus photographs and validated commercialsoftware (IVAN). Multivariate linear regression models were adopted to assess the long-term associations of the calibers of retinal microvessels with long-term changes in blood pressure and variability. Results: Thestudy cohort was composed of 3 419 subjects, including 1 428 hypertensives and 1 991 normotensives. Among hypertensive participants, after adjustments for baseline blood pressure and other potential confounders, annually increasing blood pressure was independently associated with narrower retinal arterioles (β=-0.53, P <0.001 for systolic pressure; β=-0.63, P =0.006 for diastolic pressure). The trend was also associated with narrower venules (β=-0.49, P =0.006 for systolic pressure; β=-0.73, P =0.008 for diastolic pressure). These associations were not statistically significant among normotensive participants. Conclusions: The results indicate that a rising trend in blood pressure may be an additional retinal microvascular risk factor for hypertensives.