Differential Effects of Antihypertensive Treatment on the Retinal Microcirculation: An Anglo-Scandinavian Cardiac Outcomes Trial Substudy

Changes in the retinal microcirculation are associated with hypertension and predict cardiovascular mortality. There are few data describing the impact of antihypertensive therapy on retinal vascular changes. This substudy of the Anglo-Scandinavian Cardiac Outcomes Trial compared the effects of an amlodipine-based regimen (373 patients) with an atenolol-based regimen (347 patients) on retinal microvascular measurements made from fundus photographs. The retinal photographs were taken at a stage in the trial when treatments were stable and blood pressure was well controlled. Amlodipine-based treatment was associated with a smaller arteriolar length:diameter ratio than atenolol-based treatment (13.32 [10.75 to 16.04] versus 14.12 [11.27 to 17.81], median [interquartile range]; P<0.01). The association remained significant after adjustment for age, sex, cholesterol, systolic and diastolic blood pressures, body mass index, smoking, and statin treatment. This effect appeared to be largely attributable to shorter retinal arteriolar segment lengths in the amlodipine-treated group and is best explained by the vasodilator effects of amlodipine causing the visible emergence of branching side vessels. Photographic assessment of the retinal vascular network may be a useful approach to evaluating microvascular structural responses in clinical trials of antihypertensive therapy.

[1]  N. Witt,et al.  Determinants of Retinal Microvascular Architecture in Normal Subjects , 2009, Microcirculation.

[2]  Jie-Jin Wang,et al.  Retinopathy predicts coronary heart disease mortality , 2008, Heart.

[3]  M. E. Martínez-Pérez,et al.  Effect of antihypertensive treatment on retinal microvascular changes in hypertension , 2008, Journal of hypertension.

[4]  P. Mitchell,et al.  Evidence of Arteriolar Narrowing in Low-Birth-Weight Children , 2008, Circulation.

[5]  P. Bath,et al.  Effect of antihypertensive agents on cerebral blood flow and flow velocity in acute ischaemic stroke: systematic review of controlled studies , 2008, Journal of hypertension.

[6]  Nish Chaturvedi,et al.  Impact of Size at Birth on the Microvasculature: The Avon Longitudinal Study of Parents and Children , 2007, Pediatrics.

[7]  R. Klein,et al.  Aortic Distensibility and Retinal Arteriolar Narrowing: The Multi-Ethnic Study of Atherosclerosis , 2007, Hypertension.

[8]  A. Hughes,et al.  Candesartan- and Atenolol-Based Treatments Induce Different Patterns of Carotid Artery and Left Ventricular Remodeling in Hypertension , 2006, Stroke.

[9]  R. Klein,et al.  Abnormalities of Retinal Microvascular Structure and Risk of Mortality From Ischemic Heart Disease and Stroke , 2006, Hypertension.

[10]  Neil Chapman,et al.  Quantification of topological changes in retinal vascular architecture in essential and malignant hypertension , 2006, Journal of hypertension.

[11]  Alice Stanton,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006, Circulation.

[12]  R. Collins,et al.  Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled tri , 2005, The Lancet.

[13]  Tien Yin Wong,et al.  Retinal arteriolar narrowing, hypertension, and subsequent risk of diabetes mellitus. , 2005, Archives of internal medicine.

[14]  F. Magrini,et al.  Prevalence and correlates of advanced retinopathy in a large selected hypertensive population. The Evaluation of Target Organ Damage in Hypertension (ETODH) study , 2005, Blood pressure.

[15]  A. Hofman,et al.  Are retinal arteriolar or venular diameters associated with markers for cardiovascular disorders? The Rotterdam Study. , 2004, Investigative ophthalmology & visual science.

[16]  E. Schiffrin,et al.  Effect of amlodipine compared to atenolol on small arteries of previously untreated essential hypertensive patients. , 2002, American journal of hypertension.

[17]  A. Stanton,et al.  An intensive phenotyping study to enable the future examination of genetic influences on hypertension-associated cardiovascular disease , 2001, Journal of Human Hypertension.

[18]  M. Mulvany,et al.  Vasodilatation, not hypotension, improves resistance vessel design during treatment of essential hypertension: a literature survey , 2001, Journal of hypertension.

[19]  R. Collins,et al.  Rationale, design, methods and baseline demography of participants of the Anglo-Scandinavian Cardiac Outcomes Trial , 2001, Journal of hypertension.

[20]  A. Bharath,et al.  Computer algorithms for the automated measurement of retinal arteriolar diameters , 2001, The British journal of ophthalmology.

[21]  B. Wasan,et al.  Vascular network changes in the retina with age and hypertension , 1995, Journal of hypertension.

[22]  L. Hansson,et al.  Hypertensive retinal vascular changes: relationship to left ventricular hypertrophy and arteriolar changes before and after treatment. , 1992, Blood pressure.

[23]  L. Wilkins,et al.  Pathophysiology and clinical implications of early structural changes. , 1984, Hypertension.