Arteriolar narrowing as predictor of hypertension
http://www.100md.com
《英国医生杂志》
EDITOR—Firstly, we agree that pre-existing blood pressure is an important predictor of overt hypertension. As in the Framingham study,1 our participants whose baseline blood pressure was classified as "prehypertensive" were more likely to develop clinical hypertension than those classified as "normal" (figure 2 in our paper). This effect was irrespective of retinal vessel diameters. However, direct comparison of incidence rates and odds ratios of hypertension between studies is always problematic because of differences in study population, methods, and analysis. For example, our multivariable models adjusted for baseline lipid concentrations, diabetes status, glycosylated haemoglobin concentrations, systolic and diastolic blood pressures, and pulse pressures, whereas the Framingham study adjusted only for age, sex, body mass index, and weight gain (table 5 of the Framingham study).1
Secondly, as suggested, we conducted an additional multivariable analysis adjusting for weight change (change in body mass index between the baseline and 10 year follow up). The association of retinal arteriolar narrowing and risk of hypertension was essentially similar (odds ratio of 1.76, 95% confidence intervals, 1.34-2.32, comparing lowest to highest arteriole-venule ratio).
Finally, the issue of clinical relevance was raised. We concur with Chiolero that carefully measuring blood pressure, weight and other risk factors will allow doctors to evaluate a patient's hypertension risk clinically. Our findings do show, however, that small vessel arteriolar changes play an important part in the development of hypertension, independent of previous blood pressure, weight, or weight change, and may therefore be potential targets for treatment or prevention.
Tien Wong, associate professor
Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne, VIC 3002, Australia twong@unimelb.edu.au
Anoop Shankar, research associate
Department of Ophthalmology, University of Wisconsin, Madison, WI 53726, USA
Competing interests: None declared.
References
Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham heart study: a cohort study. Lancet 2001;358: 1682-6.
Secondly, as suggested, we conducted an additional multivariable analysis adjusting for weight change (change in body mass index between the baseline and 10 year follow up). The association of retinal arteriolar narrowing and risk of hypertension was essentially similar (odds ratio of 1.76, 95% confidence intervals, 1.34-2.32, comparing lowest to highest arteriole-venule ratio).
Finally, the issue of clinical relevance was raised. We concur with Chiolero that carefully measuring blood pressure, weight and other risk factors will allow doctors to evaluate a patient's hypertension risk clinically. Our findings do show, however, that small vessel arteriolar changes play an important part in the development of hypertension, independent of previous blood pressure, weight, or weight change, and may therefore be potential targets for treatment or prevention.
Tien Wong, associate professor
Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne, VIC 3002, Australia twong@unimelb.edu.au
Anoop Shankar, research associate
Department of Ophthalmology, University of Wisconsin, Madison, WI 53726, USA
Competing interests: None declared.
References
Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham heart study: a cohort study. Lancet 2001;358: 1682-6.