Effect of Intensive Blood Pressure Lowering Treatment on Retinal Microvasculature: Secondary Analysis From ESPRIT.

Whether intensive blood pressure-lowering treatment affects retinal microvasculature remains unknown.

目前尚不清楚强化降压治疗是否会影响视网膜微血管。

The purpose of this study was to assess the effect of intensive treatment targeting systolic blood pressure <120 mm Hg on retinal microvasculature compared with standard treatment targeting systolic blood pressure <140 mm Hg.

本研究旨在评估针对收缩压<120毫米汞柱的强化治疗对视网膜微血管的影响，与针对收缩压<140毫米汞柱的标准治疗进行比较。

Methods

In a multicenter randomized trial conducted at 116 sites in China, we randomly assigned adults aged 50 years or older with high cardiovascular risk to receive intensive treatment targeting systolic blood pressure <120 mm Hg or standard treatment targeting systolic blood pressure <140 mm Hg.

在中国的116个中心进行的一项多中心随机试验中，我们随机分配了50岁或以上的高心血管风险成人，接受针对收缩压<120毫米汞柱的强化治疗或针对收缩压<140毫米汞柱的标准治疗。

A subgroup of participants at 17 sites was selected to undertake color fundus photography at a 3-year follow-up.

在17个研究点中选定了一组参与者，在3年的随访中进行彩色眼底摄影。

Retinal microvasculature measures were derived via a standard pipeline.

通过标准流程获取视网膜微血管的测量数据。

The main outcome was arteriole-venule ratio, a measure of retinal arteriolar caliber.

主要结果是动脉静脉比率，这是视网膜动脉管径的一个测量指标。

Other measures of vessel complexity, density, and tortuosity were also compared.

还比较了其他血管复杂性、密度和扭曲度的测量指标。

Subgroup analyses of sex, age, diabetes, coronary heart disease, stroke, systolic blood pressure level, hypertension duration, and pupil dilation status were performed for arteriole-venule ratio.

对性别、年龄、糖尿病、冠心病、中风、收缩压水平、高血压持续时间以及瞳孔扩大状态进行了小动脉静脉比率的亚组分析。

Results

In total, 555 participants in the intensive arm and 526 in the standard arm were included.

在强化治疗组共有555名参与者，在标准治疗组共有526名参与者。

Mean age was 62.7 ± 6.4 years, and 37.8% were women.

平均年龄为62.7 ± 6.4岁，其中37.8%为女性。

After adjusting for age and sex, the intensive arm showed increased arteriolar caliber, as evidenced by arteriole-venule ratio (β = 0.16; 95% CI: 0.05-0.28; P = 0.005) compared with the standard arm, consistent with central retinal arteriole equivalent (β = 0.14; 95% CI: 0.02-0.25; P = 0.02).

在校正年龄和性别后，强化组显示出动脉小动脉直径增加，如动脉小静脉比率所示（β = 0.16; 95% 置信区间: 0.05-0.28; P = 0.005），与标准组相比，这与中央视网膜动脉小动脉等效值一致（β = 0.14; 95% 置信区间: 0.02-0.25; P = 0.02）。

No significant results were observed for venular caliber.

未观察到静脉小管口径的显著结果。

No heterogeneity was found across subgroups.

在各亚组之间未发现异质性。

The intensive arm also showed increased arteriolar complexity, arteriolar density, and reduced vessel tortuosity compared with the standard arm.

强化治疗组相较于标准治疗组显示出增加的小动脉复杂性、小动脉密度，并且减少了血管扭曲。

Conclusions

Among hypertensive patients with high cardiovascular risk, lowering systolic blood pressure with a target of <120 mm Hg compared with <140 mm Hg has a favorable impact on retinal microvasculature, providing the first evidence that such intervention may improve systemic microcirculation and mitigate hypertension-mediated organ damage.

在具有高心血管风险的高血压患者中，将收缩压目标降低至<120毫米汞柱，与<140毫米汞柱相比，对视网膜微血管有积极影响，首次提供了这种干预可能改善全身微循环并减轻高血压介导的器官损伤的证据。

(Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing RIsk of Vascular evenTs [ESPRIT] Study; NCT04030234).

(强化收缩压降低治疗减少血管事件风险研究[ESPRIT]; NCT04030234).