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Глазное дно как орган-мишень при гипертонической болезни: обзор литературы
Глазное дно как орган-мишень при гипертонической болезни: обзор литературы
Барсуков А.В., Ясеновец М.В., Щербакова К.А., Яковлев В.В., Чумак Б.А., Борисова Е.В., Мальцев Д.С., Бурнашева М.А., Куликов А.Н. Глазное дно как орган-мишень при гипертонической болезни: обзор литературы // CardioСоматика. 2022. Т. 13, № 4. С. 213–222. DOI: https://doi.org/10.17816/CS196005
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Аннотация
В обзоре рассматриваются современные представления о гипертонической ретинопатии. Описана патоморфология гипертонической ретинопатии в зависимости от её градации. Кратко рассмотрены основные классификационные подходы, элементы патофизиологии, раскрыта клиническая значимость изменений глазного дна при артериальной гипертензии. Дана характеристика традиционным и инновационным методам оценки сетчатки, показана их значимость в аспекте прогнозирования течения гипертонической болезни. В статье отражены результаты собственных наблюдений (полученные на основе данных сканирующей лазерной офтальмоскопии и оптической когерентной томографической ангиографии), которые показали, что неосложнённое течение гипертонической болезни у лиц среднего возраста независимо от их гендерной принадлежности сопровождается отчётливой редукцией диаметра ретинальных артериол и расширением площади фовеальной аваскулярной зоны на уровне поверхностного капиллярного сплетения сетчатки. Приведены данные клинических исследований и результаты собственного наблюдения, свидетельствующие о ретинопротективной пользе антигипертензивной терапии.
Ключевые слова: артериальная гипертензия, глазное дно, гипертоническая ретинопатия, классификация, диагностика, прогноз, ретинопротективная терапия
Keywords: arterial hypertension, fundus, hypertensive retinopathy, classification, diagnosis, outcome, and treatment
Ключевые слова: артериальная гипертензия, глазное дно, гипертоническая ретинопатия, классификация, диагностика, прогноз, ретинопротективная терапия
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Keywords: arterial hypertension, fundus, hypertensive retinopathy, classification, diagnosis, outcome, and treatment
Полный текст
Список литературы
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13. Fraser-Bell S, Symes R, Vaze A. Hypertensive eye disease: a review. Clin Exp Ophthalmol. 2017;45(1):45–53. doi: 10.1111/ceo.12905
14. Dziedziak J, Zaleska-Żmijewska A, Szaflik JP, Cudnoch-Jędrzejewska A. Impact of arterial hypertension on the eye: a review of the pathogenesis, diagnostic methods, and treatment of hypertensive retinopathy. Med Sci Monit. 2022;28:e935135. doi: 10.12659/MSM.935135
15. Karaca M, Coban E, Ozdem S, et al. The association between endothelial dysfunction and hypertensive retinopathy in essential hypertension. Med Sci Monit. 2014;20:78–82. doi: 10.12659/MSM.889659
16. Liu M, Yi J, Tang W. Association between angiotensin converting enzyme gene polymorphism and essential hypertension: A systematic review and meta-analysis. J Renin Angiotensin Aldosterone Syst. 2021;22(1):1470320321995074. doi: 10.1177/1470320321995074
17. Pontremoli R, Sofia A, Ravera M, et al. The deletion polymorphism of the angiotensin l-converting enzyme gene is associated with target organ damage in essential hypertension. J Am Soc Nephrol. 1996;7(12):2550–2558. doi: 10.1681/ASN.V7122550
18. Wong TY, Klein R, Sharrett AR, et al. The prevalence and risk factors of retinal microvascular abnormalities in older persons: The Cardiovascular Health Study. Ophthalmology. 2003;110(4):658–666. doi: 10.1016/S0161-6420(02)01931-0
19. van den Born BJ, Hulsman CA, Hoekstra JB, et al. Value of routine funduscopy in patients with hypertension: systematic review. BMJ. 2005;331(7508):73. doi: 10.1136/bmj.331.7508.73
20. Erden S, Bicakci E. Hypertensive retinopathy: incidence, risk factors, and comorbidities. Clin Exp Hypertens. 2012;34(6):397–401. doi: 10.3109/10641963.2012.663028
21. Kabedi NN, Mwanza JC, Lepira FB, et al. Hypertensive retinopathy and its association with cardiovascular, renal and cerebrovascular morbidity in Congolese patients. Cardiovasc J Afr. 2014;25(5):228–232. doi: 10.5830/CVJA-2014-045
22. Del Brutto OH, Mera RM, Viteri EM, et al. Hypertensive retinopathy and cerebral small vessel disease in Amerindians living in rural Ecuador: The Atahualpa Project. Int J Cardiol. 2016;218:65–68. doi: 10.1016/j.ijcard.2016.05.020
23. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–1357. doi: 10.1097/01.hjh.0000431740.32696.cc
24. Heitmar R, Varma C, De P, et al. The relationship of systemic markers of renal function and vascular function with retinal blood vessel responses. Graefes Arch Clin Exp Ophthalmol. 2016;254(11):2257–2265. doi: 10.1007/s00417-016-3432-9
25. Wong TY, Klein R, Klein B, et al. Retinal vessel diameters and their associations with age and blood pressure. Invest Ophthalmol Vis Sci. 2003;44(11):4644–4650. doi: 10.1167/iovs.03-0079
26. Feng X, Wang H, Kong Y, et al. Diagnosis of chronic stage of hypertensive retinopathy based on spectral domain optical coherence tomography. J Clin Hypertens (Greenwich). 2020;22(7):1247–1252. doi: 10.1111/jch.13935
27. Di Marco E, Aiello F, Lombardo M, et al. A literature review of hypertensive retinopathy: systemic correlations and new technologies. Eur Rev Med Pharmacol Sci. 2022;26(18):6424–6443. doi: 10.26355/eurrev_202209_29742
28. Lee HM, Lee WH, Kim KN, et al. Changes in thickness of central macula and retinal nerve fibre layer in severe hypertensive retinopathy: a 1-year longitudinal study. Acta Ophthalmol. 2018;96(3):e386–e392. doi: 10.1111/aos.13521
29. Lim HB, Lee MW, Park JH, et al. Changes in ganglion cell-inner plexiform layer thickness and retinal microvasculature in hypertension: an optical coherence tomography angiography study. Am J Ophthalmol. 2019;199:167–176. doi: 10.1016/j.ajo.2018.11.016
30. Tan W, Yao X, Le TT, et al. The Application of optical coherence tomography angiography in systemic hypertension: A meta-analysis. Front Med (Lausanne). 2021;8:778330. doi: 10.3389/fmed.2021.778330
31. Liu Y, Li J, Pan J, et al. Morphological changes in and quantitative analysis of macular retinal microvasculature by optical coherence tomography angiography in hypertensive retinopathy. Hypertens Res. 2021;44(3):325–336. doi: 10.1038/s41440-020-00583-0
32. Ding J, Wai KL, McGeechan K, et al. Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data. J Hypertens. 2014;32(2):207–215. doi: 10.1097/HJH.0b013e32836586f4
33. Klein R, Klein BEK, Moss SE, et al. The relationship of retinopathy in persons without diabetes to the 15-year incidence of diabetes and hypertension: Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2006;104:98–107.
34. Yu T, Mitchel P, Berry G, et al. Retinopathy in older persons without diabetes and its relationship to hypertension. Arch Ophthalmol. 1998;116(1):83–89. doi: 10.1001/archopht.116.1.83
35. Sabanayagam C, Lye WK, Klein R, et al. Retinal microvascular caliber and risk of diabetes mellitus: a systematic review and participant-level meta-analysis. Diabetologia. 2015;58(11):2476–2485. doi: 10.1007/s00125-015-3717-2
36. von Hanno T, Bertelsen G, Sjolie A, et al. Retinal vascular calibers are significantly associated with cardiovascular risk factors: the Tromso Eye Study. Acta Ophthalmol. 2014;92(1):40–46. doi: 10.1111/aos.12102
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38. Shirafkan A, Motahari M, Mojerlou M, et al. Association between left ventricular hypertrophy with retinopathy and renal dysfunction in patient with essential hypertension. Singapore Med J. 2009;50(12):1177–1183.
39. Yang JY, Yang X, Li Y, et al. Carotid Atherosclerosis, Cerebrospinal Fluid Pressure, and Retinal Vessel Diameters: The Asymptomatic Polyvascular Abnormalities in Community Study. PLoS One. 2016;11(12):e0166993. doi: 10.1371/journal.pone.0166993
40. Cuspidi C, Macca G, Michev I, et al. Left ventricular concentric remodeling and extracardiac target organ damage in essential hypertension. J Hum Hypertens. 2002;16(6):385–390. doi: 10.1038/sj.jhh.1001420
41. Barsukov AV, Shcherbakova KA, Burnasheva MA, et al. Gender characteristics of retinal parameters in uncomplicated hypertension. Cardiovascular Therapy and Prevention. 2020;19(4):24–30. (In Russ). doi: 10.15829/1728-8800-2020-2500
42. Henderson AD, Bruce BB, Newman NJ, Biousse V. Hypertension-related eye abnormalities and the risk of stroke. Rev Neurol Dis. 2011;8(1–2):1–9.
43. French C, Cubbidge RP, Heitmar R. The application of arterio-venous ratio (AVR) cut-off values in clinic to stratify cardiovascular risk in patients. Ophthalmic Physiol Opt. 2022;42(4):666–674. doi: 10.1111/opo.12967
44. Daholf B, Pennert K, Hansson L. Reversal of left ventricular hypertrophy in hypertensive patients – A meta-analysis of 109 treatment studies. Am J Hypertens. 1992;5(2):95–110. doi: 10.1093/ajh/5.2.95
45. Dolan E, Stanton AV, Thom S, et al. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients an Anglo-Scandinavian cardiac outcomes trial substudy. J Hypertens. 2009;27(4):876–885. doi: 10.1097/HJH.0b013e328322cd62
46. Debbabi H, Bonnin P, Levy BI. Effects of blood pressure control with perindopril/indapamide on the microcirculation in hypertensive patients. Am J Hypertens. 2010;23(10):1136–1143. doi: 10.1038/ajh.2010.115
47. De Ciuceis C, Salvetti M, Rossini C, et al. Effect of antihypertensive treatment on microvascular structure, central blood pressure and oxidative stress in patients with mild essential hypertension. J Hypertens. 2014;32(3):565–574. doi: 10.1097/HJH.0000000000000067
2. Zhou B., Perel P., Mensah G.A., Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension // Nat Rev Cardiol. 2021. Vol. 18, N 11. P. 785–802. doi: 10.1038/s41569-021-00559-8
3. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension // Eur Heart J. 2018. Vol. 39, N 33. P. 3021–3104. doi: 10.1093/eurheartj/ehy339
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________________________________________________
2. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. 2021;18(11):785–802. doi: 10.1038/s41569-021-00559-8
3. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–3104. doi: 10.1093/eurheartj/ehy339
4. Kobalava ZD, Konradi AO, Nedogoda SV, et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):149–218. (In Russ). doi: 10.15829/1560-4071-2020-3-3786
5. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–3337. doi: 10.1093/eurheartj/ehab484
6. Chazova IE, Zhernakova YuV on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6–31. (In Russ). doi: 10.26442/2075082X.2019.1.190179
7. Kryukov EV, Fursov AN, Potekhin NP, et al. Hypertensive crisis – clinical interpretation of the term. Clinical Medicine. 2021;99(2):146–149. (In Russ). doi: 10.30629/0023-2149-2021-99-2-146-149
8. Ahn SJ, Woo SJ, Park KH. Retinal and choroidal changes with severe hypertension and their association with visual outcome. Invest Ophthalmol Vis Sci. 2014;55(12):7775–7785. doi: 10.1167/iovs.14-14915
9. Liebreich R. Ophthalmoskopischer befund bei morbus brightii. Archiv für Opthalmologie. 1859;5:265–268. (In German).
10. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1974;268(6):336–345. doi: 10.1097/00000441-197412000-00004
11. Garner A, Ashton N. Pathogenesis of hypertensive retinopathy: a review. J R Soc Med. 1979;72(5):362–365. doi: 10.1177/014107687907200510
12. Modi P, Arsiwalla T. Hypertensive Retinopathy. Treasure Island (FL): StatPearls Publishing; 2022.
13. Fraser-Bell S, Symes R, Vaze A. Hypertensive eye disease: a review. Clin Exp Ophthalmol. 2017;45(1):45–53. doi: 10.1111/ceo.12905
14. Dziedziak J, Zaleska-Żmijewska A, Szaflik JP, Cudnoch-Jędrzejewska A. Impact of arterial hypertension on the eye: a review of the pathogenesis, diagnostic methods, and treatment of hypertensive retinopathy. Med Sci Monit. 2022;28:e935135. doi: 10.12659/MSM.935135
15. Karaca M, Coban E, Ozdem S, et al. The association between endothelial dysfunction and hypertensive retinopathy in essential hypertension. Med Sci Monit. 2014;20:78–82. doi: 10.12659/MSM.889659
16. Liu M, Yi J, Tang W. Association between angiotensin converting enzyme gene polymorphism and essential hypertension: A systematic review and meta-analysis. J Renin Angiotensin Aldosterone Syst. 2021;22(1):1470320321995074. doi: 10.1177/1470320321995074
17. Pontremoli R, Sofia A, Ravera M, et al. The deletion polymorphism of the angiotensin l-converting enzyme gene is associated with target organ damage in essential hypertension. J Am Soc Nephrol. 1996;7(12):2550–2558. doi: 10.1681/ASN.V7122550
18. Wong TY, Klein R, Sharrett AR, et al. The prevalence and risk factors of retinal microvascular abnormalities in older persons: The Cardiovascular Health Study. Ophthalmology. 2003;110(4):658–666. doi: 10.1016/S0161-6420(02)01931-0
19. van den Born BJ, Hulsman CA, Hoekstra JB, et al. Value of routine funduscopy in patients with hypertension: systematic review. BMJ. 2005;331(7508):73. doi: 10.1136/bmj.331.7508.73
20. Erden S, Bicakci E. Hypertensive retinopathy: incidence, risk factors, and comorbidities. Clin Exp Hypertens. 2012;34(6):397–401. doi: 10.3109/10641963.2012.663028
21. Kabedi NN, Mwanza JC, Lepira FB, et al. Hypertensive retinopathy and its association with cardiovascular, renal and cerebrovascular morbidity in Congolese patients. Cardiovasc J Afr. 2014;25(5):228–232. doi: 10.5830/CVJA-2014-045
22. Del Brutto OH, Mera RM, Viteri EM, et al. Hypertensive retinopathy and cerebral small vessel disease in Amerindians living in rural Ecuador: The Atahualpa Project. Int J Cardiol. 2016;218:65–68. doi: 10.1016/j.ijcard.2016.05.020
23. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–1357. doi: 10.1097/01.hjh.0000431740.32696.cc
24. Heitmar R, Varma C, De P, et al. The relationship of systemic markers of renal function and vascular function with retinal blood vessel responses. Graefes Arch Clin Exp Ophthalmol. 2016;254(11):2257–2265. doi: 10.1007/s00417-016-3432-9
25. Wong TY, Klein R, Klein B, et al. Retinal vessel diameters and their associations with age and blood pressure. Invest Ophthalmol Vis Sci. 2003;44(11):4644–4650. doi: 10.1167/iovs.03-0079
26. Feng X, Wang H, Kong Y, et al. Diagnosis of chronic stage of hypertensive retinopathy based on spectral domain optical coherence tomography. J Clin Hypertens (Greenwich). 2020;22(7):1247–1252. doi: 10.1111/jch.13935
27. Di Marco E, Aiello F, Lombardo M, et al. A literature review of hypertensive retinopathy: systemic correlations and new technologies. Eur Rev Med Pharmacol Sci. 2022;26(18):6424–6443. doi: 10.26355/eurrev_202209_29742
28. Lee HM, Lee WH, Kim KN, et al. Changes in thickness of central macula and retinal nerve fibre layer in severe hypertensive retinopathy: a 1-year longitudinal study. Acta Ophthalmol. 2018;96(3):e386–e392. doi: 10.1111/aos.13521
29. Lim HB, Lee MW, Park JH, et al. Changes in ganglion cell-inner plexiform layer thickness and retinal microvasculature in hypertension: an optical coherence tomography angiography study. Am J Ophthalmol. 2019;199:167–176. doi: 10.1016/j.ajo.2018.11.016
30. Tan W, Yao X, Le TT, et al. The Application of optical coherence tomography angiography in systemic hypertension: A meta-analysis. Front Med (Lausanne). 2021;8:778330. doi: 10.3389/fmed.2021.778330
31. Liu Y, Li J, Pan J, et al. Morphological changes in and quantitative analysis of macular retinal microvasculature by optical coherence tomography angiography in hypertensive retinopathy. Hypertens Res. 2021;44(3):325–336. doi: 10.1038/s41440-020-00583-0
32. Ding J, Wai KL, McGeechan K, et al. Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data. J Hypertens. 2014;32(2):207–215. doi: 10.1097/HJH.0b013e32836586f4
33. Klein R, Klein BEK, Moss SE, et al. The relationship of retinopathy in persons without diabetes to the 15-year incidence of diabetes and hypertension: Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2006;104:98–107.
34. Yu T, Mitchel P, Berry G, et al. Retinopathy in older persons without diabetes and its relationship to hypertension. Arch Ophthalmol. 1998;116(1):83–89. doi: 10.1001/archopht.116.1.83
35. Sabanayagam C, Lye WK, Klein R, et al. Retinal microvascular caliber and risk of diabetes mellitus: a systematic review and participant-level meta-analysis. Diabetologia. 2015;58(11):2476–2485. doi: 10.1007/s00125-015-3717-2
36. von Hanno T, Bertelsen G, Sjolie A, et al. Retinal vascular calibers are significantly associated with cardiovascular risk factors: the Tromso Eye Study. Acta Ophthalmol. 2014;92(1):40–46. doi: 10.1111/aos.12102
37. Barsukov AV, Shcherbakova KA, Maltsev DS, et al. The relationship of the state of the retinal with other organ changes with uncomplicated hypertension. Arterial Hypertension. 2020;26(4):410–420. (In Russ). doi: 10.18705/1607-419X-2020-26-4-410-420
38. Shirafkan A, Motahari M, Mojerlou M, et al. Association between left ventricular hypertrophy with retinopathy and renal dysfunction in patient with essential hypertension. Singapore Med J. 2009;50(12):1177–1183.
39. Yang JY, Yang X, Li Y, et al. Carotid Atherosclerosis, Cerebrospinal Fluid Pressure, and Retinal Vessel Diameters: The Asymptomatic Polyvascular Abnormalities in Community Study. PLoS One. 2016;11(12):e0166993. doi: 10.1371/journal.pone.0166993
40. Cuspidi C, Macca G, Michev I, et al. Left ventricular concentric remodeling and extracardiac target organ damage in essential hypertension. J Hum Hypertens. 2002;16(6):385–390. doi: 10.1038/sj.jhh.1001420
41. Barsukov AV, Shcherbakova KA, Burnasheva MA, et al. Gender characteristics of retinal parameters in uncomplicated hypertension. Cardiovascular Therapy and Prevention. 2020;19(4):24–30. (In Russ). doi: 10.15829/1728-8800-2020-2500
42. Henderson AD, Bruce BB, Newman NJ, Biousse V. Hypertension-related eye abnormalities and the risk of stroke. Rev Neurol Dis. 2011;8(1–2):1–9.
43. French C, Cubbidge RP, Heitmar R. The application of arterio-venous ratio (AVR) cut-off values in clinic to stratify cardiovascular risk in patients. Ophthalmic Physiol Opt. 2022;42(4):666–674. doi: 10.1111/opo.12967
44. Daholf B, Pennert K, Hansson L. Reversal of left ventricular hypertrophy in hypertensive patients – A meta-analysis of 109 treatment studies. Am J Hypertens. 1992;5(2):95–110. doi: 10.1093/ajh/5.2.95
45. Dolan E, Stanton AV, Thom S, et al. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients an Anglo-Scandinavian cardiac outcomes trial substudy. J Hypertens. 2009;27(4):876–885. doi: 10.1097/HJH.0b013e328322cd62
46. Debbabi H, Bonnin P, Levy BI. Effects of blood pressure control with perindopril/indapamide on the microcirculation in hypertensive patients. Am J Hypertens. 2010;23(10):1136–1143. doi: 10.1038/ajh.2010.115
47. De Ciuceis C, Salvetti M, Rossini C, et al. Effect of antihypertensive treatment on microvascular structure, central blood pressure and oxidative stress in patients with mild essential hypertension. J Hypertens. 2014;32(3):565–574. doi: 10.1097/HJH.0000000000000067
Авторы
А.В. Барсуков*1,2, М.В. Ясеновец2, К.А. Щербакова2, В.В. Яковлев2, Б.А. Чумак2, Е.В. Борисова1, Д.С. Мальцев2, М.А. Бурнашева2, А.Н. Куликов2
1 АО «КардиоКлиника», Санкт-Петербург, Россия;
2 ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, Санкт-Петербург, Россия
*avbarsukov@yandex.ru
1 CardioClinic, Saint Petersburg, Russia;
2 Kirov Military Medical Academy, St. Petersburg, Russia
*avbarsukov@yandex.ru
1 АО «КардиоКлиника», Санкт-Петербург, Россия;
2 ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, Санкт-Петербург, Россия
*avbarsukov@yandex.ru
________________________________________________
1 CardioClinic, Saint Petersburg, Russia;
2 Kirov Military Medical Academy, St. Petersburg, Russia
*avbarsukov@yandex.ru
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