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(Hypertension. 2008;51:821.)
© 2008 American Heart Association, Inc.

Editorial Commentaries

Retinal Microcirculation and Early Mechanisms of Hypertension

Harry A.J. Struijker-Boudier

From the Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, The Netherlands.

Correspondence to Harry A.J. Struijker-Boudier, Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands. E-mail h.struijkerboudier@farmaco.unimaas.nl

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The microcirculation plays a critical role in the pathophysiology of hypertension.^1,2 The increase in peripheral resistance underlying the raised blood pressure is localized primarily in small arteries (diameter 150 to 300 µm) and arterioles (diameter 10 to 150 µm). The rise in blood pressure causes a further narrowing of small arteries and rarefaction of capillaries and precapillary arterioles, thus creating a vicious cycle. This cycle has been well documented in several animal models of hypertension. However, it has been more difficult to grasp the complete picture in humans, because of technical difficulties to evaluate the microcirculation in vivo. The study of small arteries in humans is based on biopsies usually taken from subcutaneous fat tissue. Using this approach Rizzoni et al^3,4 were able to show that small artery narrowing predicts the prevalence of cardiovascular complications in both normotensive and hypertensive individuals. Capillary rarefaction has been assessed in humans using in vivo capillaroscopy of the nailfold microvasculature. The majority of these studies support the hypothesis of capillary rarefaction as an early hallmark of hypertension.^1,5,6 In the last few years, advances in retinal photography and computing technologies have enabled objective measurement of small artery and arteriolar vessel size from digital retinal images. Several large population-based studies have applied this approach to quantitatively determine retinal vessel diameters and have documented a consistent association between elevated blood pressure and narrowed retinal arterioles.^7–9 Similar studies also indicated that retinal arteriolar narrowing predicts the future blood pressure elevation in previously normotensive persons.^10–12

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