Lumen narrowing and increased wall to lumen ratio of retinal microcirculation are valuable biomarkers of hypertension-mediated cardiac damage

Figures & data

Table 1. Baseline characteristics of the study group.

				p-value, post-hoc test
	NT, N = 32	HT without cardiac damage, N = 55	HT with cardiac damage, N = 33	NT vs. HT without cardiac damage	NT vs. HT with cardiac damage	HT with vs. without cardiac damage
Gender, males [%]	37.5	61.8	60.6	NS	NS	NS
Age [y]	54.5 (46.8–58.2)	53.6 (9.1)	57 (50–64)	NS	NS	NS
BMI [kg/m^2]	25.7 (3.9)	28.6 (4.6)	31.3 (4.2)	<0.001	<0.001	<0.001
WHR[–]	0.88 (0.08)	0.91 (0.1)	0.94 (0.07)	NS	0.01	NS
bSBP [mm Hg]	120 (115–128)	132.9 (11.4)	137 (129–148)	n.a.	n.a.	0.02
bDBP [mm Hg]	70 (66–76.5)	77.1 (7.6)	77 (75–86)	n.a.	n.a.	NS
bMBP[mm Hg]	89.5 (84.5–96)	99.4 (8.4)	104 (94.4–110.4)	n.a.	n.a.	0.03
bPP [mm Hg]	50.5 (46.8–54)	55.8 (8.4)	60 (51–62)	n.a.	n.a.	NS
GLC [mg/dL]	90.4 (8.7)	95.0 (9.3)	97.7 (9.1)	NS	0.005	NS
Creatinine serum [mg/dL]	0.81 (0.76–0.96)	0.9 (0.2)	0.81 (0.73–0.9)	NS	NS	NS
eGFR [ml/min/1,73m²]	84.1 (11.8)	87.4 (15.4)	95.5 (16.1)	NS	0.008	0.045
UA [mg/dL]	5.0 (1.26)	5.9 (1.4)	6.1 (1.17)	0.02	0.004	NS
HDL [mg/dL]	58 (50.8–71)	55 (44–63)	52.5 (45–61.8)	NS	NS	NS
TG [mg/dL]	93.5 (71.8–115.8)	117 (83–180)	124.5 (89.3–184.2)	NS	NS	NS
LDL [mg/dL]	141 (119–163)	116.4 (28.0)	108 (91–140)	0.006	0.045	NS
HB [g/dL]	14.1 (1.31)	14.6 (1.2)	14.7 (1.12)	NS	NS	NS
RBC [10^6/µL]	4.55 (4.34–4.91)	4.8 (0.4)	4.81 (4.5–5.15)	NS	NS	NS
PLT [G/L]	260.2 (60.7)	237.0 (39.2)	238.8 (54.9)	NS	NS	NS
WBC [G/L]	6 (5–6.7)	6.4 (1.5)	6.5 (4.9–7.2)	NS	NS	NS
Smoker [%]	28.1	23.6	21.2	NS	NS	NS
Pharmacological treatment				p-value chi-square test
ACE-I [%]	–	38.2	39.4	–	–	NS
ARB [%]	–	45.5	51.5	–	–	NS
RAAS blockers[%]	–	83.7	90.9	–	–	NS
CCB [%]	–	36.4	60.6	–	–	0.03
Beta-blockers [%]	–	47.3	51.5	–	–	NS
Thiazides [%]	–	34.5	48.5	–	–	NS
Statins [%]	–	36.4	60.6	–	–	0.03

Data are presented as mean ± standard deviation or median and interquartile range. ACE-I: angiotensin converting enzyme inhibitors, ARB: angiotensin receptor blockers, BMI: body mass index, bSBP: brachial systolic blood pressure, bDBP: brachial diastolic blood pressure, bMBP: brachial mean blood pressure, bPP: brachial pulse pressure, CCB: calcium channel blockers, eGFR: estimated glomerular filtration rate, GLC: fasting glucose, HB: hemoglobin, HDL: high-density lipoprotein, LDL: low density lipoprotein, n.a.: not applicable, PLT: platelet count, RBC: red blood cell count, TG: triglycerides, UA: uric acid, WBC: white blood cell count.

Table 3. Multivariate regression analysis evaluating the association of retinal parameters with cardiac damage indices

	β	95% CI	p-value		β	95% CI	p-value
IVSD [mm]
LD [µm]	−0.05	−0.10––0.003	0.03	WLR [µm]	3.67	0.57–6.77	0.02
Age [y]	0.03	−0.02–0.08	0.19	Age [y]	0.02	−0.03–0.07	0.35
Sex [–]	1.37	0.58–2.17	<0.001	Sex [-]	1.36	0.56–2.15	0.001
bMBP [mm Hg]	0.05	0.02–0.08	0.004	bMBP [mm Hg]	0.06	0.02–0.09	<0.001
LVM [g]
LD [µm]	−1.15	−2.25––0.05	0.04	WLR [µm]	56.87	−8.86–132.59	0.14
Age [y]	0.45	−0.71–1.62	0.44	Age [y]	0.25	−0.93–1.42	0.68
Sex [–]	50.58	31.46–69.71	<0.001	Sex [–]	50.41	31.05–69.76	<0.001
bMBP [mm Hg]	0.95	0.15–1.74	0.02	bMBP [mm Hg]	1.11	0.31–1.90	0.007
LAV [mL]
LD [µm]	−0.42	−0.83––0.006	0.047	WLR [µm]	30.00	2.08–57.92	0.04
Age [y]	0.30	−0.14–0.73	0.18	Age [y]	0.21	−0.22–0.64	0.34
Sex [–]	11.29	3.96–18.62	0.003	Sex [–]	11.16	3.85–18.48	0.003
bMBP [mm Hg]	0.22	−0.08–0.52	0.15	bMBP [mm Hg]	0.28	−0.02–0.58	0.06

bMBP: brachial office mean blood pressure, β: beta coefficient, CI: confidence interval, IVSD: intraventricular septum diameter, LAV: left atrial volume, LD: lumen diameter, LVM: left ventricular mass, WLR: wall to lumen ratio, age: 1 year increase; bMBP: 1 mm Hg increase, sex indicates males.

Figure 1. Lumen diameter of retinal arterioles in 3 subgroups: 0 – healthy subjects, 1 – hypertensive patients without cardiac damage, 3 – hypertensive patients with cardiac damage. The narrowest lumen corresponds to the presence of cardiac damage (Jonckheere-Terpstra trend test).

Figure 2. Correlation analysis between cardiac and retinal parameters. Structural microvascular abnormalities are associated with indices of cardiac damage: lumen diameter (LD) is associated with intraventricular septum (IVSD), left ventricular mass (LVM) and left atrial volume (LAV), whereas wall to lumen ratio (WLR) is associated with IVSD and LAV (Spearman’s rank correlation analysis).