ABSTRACT
The clinical and prognostic significance of initial retinal changes in hypertensive patients remains controversial. So, we assessed the relationship of microvascular abnormalities with prognostically validated markers of target organ damage [TOD], such as left ventricular mass [LVM], carotid intima-media thickness [IMT] and microalbuminuria, in early stages of untreated essential hypertension. A total of 280 consecutive, never-treated patients with grade 1 or 2 essential hypertension, referred to outpatient clinic, underwent the following procedures: [1] clinical and routine laboratory examinations, [2] 24-h ambulatory blood pressure monitoring, [3] 24-h urine collection for microalbuminuria, [4] transthoracic echo-Doppler evaluation, [5] carotid ultrasonography, [6] mydriatic retinography. Patients were divided into three groups; group I, with normal retinal pattern [n =67, 24%], group II arteriolar narrowing [n = 93, 32.2%] and group III with arteriovenous crossings [n =120, 42.9%]. The three groups were similar for gender, body mass index, smoking habit, heart rate, clinic and ambulatory blood pressure [BP] values, while mean age was slightly but significantly higher in group III than in group I[47.6 +/- 10.7 versus 43.6 +/- 11.5 years, P = 0.03]. slight but significant differences occurred between group III and group I in LVM index [112.5 +/- 19 versus 102.1 +/- 11 g/m2, p<0.04], carotid IMT 0.78 +/- 0.18 versus 0.64 +/- 0.12 mm, p<0.05], urinary albumin excretion rate [18.4 +/- 28.4 versus 12.6 +/- 26 mg/ 24h, p<0.05] as well as in the prevalence of LV hypertrophy [15.3 versus 8.10%, p<0.006], IM thickening and plaques [28.78, 23.54% versus 15.6 and 13.5%, p<0.008, 0.006] both defined according to 2003 ESH-ESC guidelines]. These results show that: [1] a large fraction [more than 76%] of untreated, recently diagnosed hypertensive patients have initial retinal microvascular abnormalities detectable by mydriatic retinography, [2] the presence of diffuse arteriolar narrowing is not associated with more prominent cardiac and extracardiac TOD, while the presence of arteriovenous crossings are associated, [3] fundoscopic examination has a valuable clinical value to detect widespread organ involvement in grade 1 and 2 recently diagnosed hypertension