UNLABELLED: Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals. DESIGN AND METHOD: A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n = 213), treated controlled hypertensive individuals ( n = 30), treated uncontrolled hypertensive individuals ( n = 26), and newly detected/untreated hypertensive individuals ( n = 73). RESULTS: There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals. CONCLUSION: Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.

2nd Department of Internal Medicine Faculty of Medicine Charles University Pilsen

Center for Cardiovascular Prevention Charles University Prague 1st Faculty of Medicine and Thomayer University Hospital

Department of Human Physiology and Pathophysiology University of Warmia and Mazury Olsztyn Poland

Department of Medicine 2 Charles University Prague 1st Faculty of Medicine Prague Czech Republic

Department of Nephrology and Hypertension University Hospital Erlangen Friedrich Alexander University Erlangen Nürnberg Germany

Medical Statistics Unit Institute for Clinical and Experimental Medicine Prague Czech Republic

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GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. PubMed PMC

Mulvany MJ, Aalkjaer C. Structure and function of small arteries. PubMed

Struijker-Boudier HA, Rosei AE, Bruneval P, Camici PG, Christ F, Henrion D, et al. Evaluation of the microcirculation in hypertension and cardiovascular disease. PubMed

Levy BI, Schiffrin EL, Mourad JJ, Agostini D, Vicaut E, Safar ME, et al. Impaired tissue perfusion: a pathology common to hypertension, obesity, and diabetes mellitus. PubMed

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. PubMed

Breslin DJ, Gifford RW, Jr, Fairbairn JF, 2nd, Kearns TP. Prognostic importance of ophthalmoscopic findings in essential hypertension. PubMed

Frant R, Groen J. Prognosis of vascular hypertension; a 9 year follow-up study of 418 cases. PubMed

Sairenchi T, Iso H, Yamagishi K, Irie F, Okubo Y, Gunji J, et al. Mild retinopathy is a risk factor for cardiovascular mortality in Japanese with and without hypertension: the Ibaraki Prefectural Health Study. PubMed

Dimmitt SB, West JN, Eames SM, Gibson JM, Gosling P, Littler WA. Usefulness of ophthalmoscopy in mild to moderate hypertension. PubMed

Allon R, Aronov M, Belkin M, Maor E, Shechter M, Fabian ID. Retinal microvascular signs as screening and prognostic factors for cardiac disease: a systematic review of current evidence. PubMed

Harazny JM, Ritt M, Baleanu D, Ott C, Heckmann J, Schlaich MP, et al. Increased wall:lumen ratio of retinal arterioles in male patients with a history of a cerebrovascular event. PubMed

Ritt M, Harazny JM, Ott C, Schlaich MP, Schneider MP, Michelson G, et al. Analysis of retinal arteriolar structure in never-treated patients with essential hypertension. PubMed

Harazny JM, Raff U, Welzenbach J, Ott C, Ritt M, Lehmann M, et al. New software analyses increase the reliability of measurements of retinal arterioles morphology by scanning laser Doppler flowmetry in humans. PubMed

Cífková R, Bruthans J, Wohlfahrt P, Krajčoviechová A, Šulc P, Jozífová M, et al. 30-year trends in major cardiovascular risk factors in the Czech population, Czech MONICA and Czech post-MONICA, 1985-2016/17. PubMed PMC

Wohlfahrt P, Krajčoviechová A, Seidlerová J, Galovcová M, Bruthans J, Filipovský J, et al. Lower-extremity arterial stiffness vs. aortic stiffness in the general population. PubMed

Michelson G, Welzenbach J, Pal I, Harazny J. Automatic full field analysis of perfusion images gained by scanning laser Doppler flowmetry. PubMed PMC

Ritt M, Harazny JM, Ott C, Schneider MP, Schlaich MP, Michelson G, et al. Wall-to-lumen ratio of retinal arterioles is related with urinary albumin excretion and altered vascular reactivity to infusion of the nitric oxide synthase inhibitor N-monomethyl-L-arginine. PubMed

Hua D, Xu Y, Zhang X, He T, Chen C, Chen Z, et al. Retinal microvascular changes in hypertensive patients with different levels of blood pressure control and without hypertensive retinopathy. PubMed

Schiffrin EL. Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. PubMed

Rizzoni D, Porteri E, Duse S, De Ciuceis C, Rosei CA, La Boria E, et al. Relationship between media-to-lumen ratio of subcutaneous small arteries and wall-to-lumen ratio of retinal arterioles evaluated noninvasively by scanning laser Doppler flowmetry. PubMed

Cífková R, Harazny JM, Bruthans J, Wohlfahrt P, Krajčoviechová A, Lánská V, et al. Reference values of retinal microcirculation parameters derived from a population random sample. PubMed

Ritt M, Schmieder RE. Wall-to-lumen ratio of retinal arterioles as a tool to assess vascular changes. PubMed