Key result
Cumulative diastolic, but not systolic, BP is linked to ~1.8-μm narrower retinal arterioles per SD.
Why the study?
The associations of time-averaged cumulative blood pressure from midlife to late life with microvasculature expressed as retinal vessel diameters were not well studied, particularly regarding race differences.
Does higher time-averaged cumulative systolic and diastolic blood pressure from midlife to late life associate with narrower late-life retinal microvascular diameters in Black and White adults?
Cohort (n=1,818)
Yes
Does higher time-averaged cumulative systolic and diastolic blood pressure from midlife to late life associate with narrower late-life retinal microvascular diameters in Black and White adults?
Long-term cumulative diastolic blood pressure from midlife to late life—rather than systolic blood pressure—is the dominant blood pressure driver of late-life retinal arteriolar narrowing, with distinct race-specific microvascular vulnerability patterns between Black and White adults.
Retinal arteriolar narrowing may reflect cumulative diastolic rather than systolic BP exposure; leaves open clinical relevance and need for prospective validation.
Background The associations of time‐averaged cumulative blood pressure (BP) from midlife to late life with microvasculature expressed as retinal vessel diameters is not well studied. The aim of this study was to evaluate the association of cumulative systolic BP and diastolic BP (DBP) with retinal vessel calibers, focusing on race differences. Methods and Results The analysis included 1818 adults from the ARIC (Atherosclerosis Risk in Communities) study attending the fifth visit (2011–2013; age 77±5 years, 17.1% Black participants). Time‐averaged cumulative BPs were calculated as the sum of averaged BPs from adjacent consecutive visits (visits 1–5) indexed to total observation time (24±1 years). Summarized estimates for central retinal arteriolar equivalent and central retinal venular equivalent at the fifth visit represent average retinal vessel diameters. The arteriole:venule ratio was calculated. We tested for effect modification by race. Results from multiple linear regression models suggested that higher time‐averaged cumulative DBP (β [95% CI] per 1‐SD increase: −1.78 [−2.53, −1.02], P <0.001 and −0.005 [−0.009, −0.002], P =0.004, respectively) but not systolic BP (−0.52 [−1.30, 0.26], P =0.189 and 0.001 [−0.002, 0.005], P =0.485, respectively) was associated with smaller central retinal arteriolar equivalent and arteriole:venule ratio. The association between time‐averaged cumulative DBP and arteriole:venule ratio was strongest in White participants (interaction P =0.007). The association of cumulative systolic BP and DBP with central retinal venular equivalent was strongest in Black participants (interaction P =0.015 and 0.011, respectively). Conclusions Exposure to higher BP levels, particularly DBP, from midlife to late life is associated with narrower retinal vessel diameters in late life. Furthermore, race moderated the association of cumulative BP exposure with retinal microvasculature.
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Huang et al. (2022) conducted a cohort in Mid- to late-life blood pressure exposure and retinal microvasculature abnormalities (n=1,818). Time-averaged cumulative diastolic blood pressure (per 1-SD increase) and systolic blood pressure from midlife to late life was evaluated on Central retinal arteriolar equivalent (CRAE, μm) at visit 5 (β -1.78 μm per 1-SD increase in cumulative DBP (OR 1.25 for lowest quintile CRAE narrowing), 95% CI -2.53 to -1.02, p=<0.001). Higher 24-year cumulative diastolic blood pressure was associated with narrower late-life central retinal arteriolar equivalent (β -1.78 μm per 1-SD increase, P<0.001), whereas cumulative systolic blood pressure was not.
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