Published Online
on April 8, 2004

A more recent version of this article appeared on June 1, 2004

This Article Full Text (PDF) All Versions of this Article: 35/6/1289    most recent 01.STR.0000126597.11534.3bv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Delles, C. Articles by Schmieder, R. E. Search for Related Content PubMed PubMed Citation Articles by Delles, C. Articles by Schmieder, R. E. Related Collections Cerebrovascular disease/stroke Hypertension - basic studies Other Treatment Doppler ultrasound, Transcranial Doppler etc. Other imaging Endothelium/vascular type/nitric oxide

Submitted on December 4, 2003
Revised on January 12, 2004
Accepted on February 10, 2004

Impaired Endothelial Function of the Retinal Vasculature in Hypertensive Patients

Christian Delles MD; Georg Michelson MD; Joanna Harazny PhD; Sebastian Oehmer MD; Karl F. Hilgers MD; and Roland E. Schmieder MD, FACC^*

From Departments of Nephrology (C.D., S.O., K.F.H., R.E.S.) and Ophthalmology (G.M., J.H.), University of Erlangen-Nürnberg, Erlangen, Germany.

^* To whom correspondence should be addressed. E-mail: roland.schmieder{at}rzmail.uni-erlangen.de.

Background and Purpose--Arterial hypertension constitutes a central factor in the pathogenesis of stroke. We examined endothelial function of the retinal vasculature as a model of the cerebral circulation.

Methods--Thirty-eight young subjects (19 hypertensive and 19 normotensive) were treated with the AT₁-receptor blocker candesartan cilexetil and placebo, each over 7 days. Retinal capillary flow and blood flow velocity in the central retinal artery were assessed with scanning laser Doppler flowmetry and pulsed Doppler ultrasound, respectively. N^G-monomethyl-L-arginine (L-NMMA) was infused to inhibit nitric oxide (NO) synthesis. Diffuse luminance flicker was applied to stimulate NO release.

Results--In normotensive subjects, L-NMMA decreased retinal capillary flow by 8.2%±13% (P<0.05) and flickering light increased mean blood flow velocity in the central retinal artery by 19%±29% (P<0.01). In contrast, no significant change to these provocative tests was seen in hypertensive subjects. Treatment with candesartan cilexetil restored a normal pattern of reactivity in retinal capillaries (L-NMMA: decrease in perfusion by 10%±17%, P<0.05) and the central retinal artery (flicker: increase in mean blood flow velocity by 42%±31%, P<0.001) in hypertensive patients.

Conclusions--Endothelial function of the retinal vasculature is impaired in early essential hypertension but can be improved by AT₁-receptor blockade.

Key words: cerebrovascular circulation • endothelium • hypertension • angiotensins • nitric oxide

This article has been cited by other articles:

				R. E. Schmieder Hypertensive Retinopathy: A Window to Vascular Remodeling in Arterial Hypertension Hypertension, January 1, 2008; 51(1): 43 - 44. [Full Text] [PDF]

				H. Kan, J. Stevens, G. Heiss, R. Klein, K. M Rose, and S. J London Dietary fiber intake and retinal vascular caliber in the Atherosclerosis Risk in Communities Study Am. J. Clinical Nutrition, December 1, 2007; 86(6): 1626 - 1632. [Abstract] [Full Text] [PDF]

				A. Mandecka, J. Dawczynski, M. Blum, N. Muller, C. Kloos, G. Wolf, W. Vilser, H. Hoyer, and U. A. Muller Influence of Flickering Light on the Retinal Vessels in Diabetic Patients Diabetes Care, December 1, 2007; 30(12): 3048 - 3052. [Abstract] [Full Text] [PDF]

				R. M. Touyz Vascular Remodeling, Retinal Arteries, and Hypertension Hypertension, October 1, 2007; 50(4): 603 - 604. [Full Text] [PDF]

				N. Toda, K. Ayajiki, and T. Okamura Interaction of Endothelial Nitric Oxide and Angiotensin in the Circulation Pharmacol. Rev., March 1, 2007; 59(1): 54 - 87. [Abstract] [Full Text] [PDF]

				T. Y. Wong, A. Kamineni, R. Klein, A. R. Sharrett, B. E. Klein, D. S. Siscovick, M. Cushman, and B. B. Duncan Quantitative Retinal Venular Caliber and Risk of Cardiovascular Disease in Older Persons: The Cardiovascular Health Study Arch Intern Med, November 27, 2006; 166(21): 2388 - 2394. [Abstract] [Full Text] [PDF]

				E. Polska, J. Kolodjaschna, F. Berisha, M. M. Malec, C. Simader, M. Bayerle-Eder, M. Roden, and L. Schmetterer C-Peptide does not affect ocular blood flow in patients with type 1 diabetes. Diabetes Care, September 1, 2006; 29(9): 2034 - 2038. [Abstract] [Full Text] [PDF]

				T. Y. Wong, F. M. A. Islam, R. Klein, B. E. K. Klein, M. F. Cotch, C. Castro, A. R. Sharrett, and E. Shahar Retinal Vascular Caliber, Cardiovascular Risk Factors, and Inflammation: The Multi-Ethnic Study of Atherosclerosis (MESA). Invest. Ophthalmol. Vis. Sci., June 1, 2006; 47(6): 2341 - 2350. [Abstract] [Full Text] [PDF]

				M. K. Ikram, J. C.M. Witteman, J. R. Vingerling, M. M.B. Breteler, A. Hofman, and P. T.V.M. de Jong Retinal Vessel Diameters and Risk of Hypertension: The Rotterdam Study Hypertension, February 1, 2006; 47(2): 189 - 194. [Abstract] [Full Text] [PDF]

				A Grosso, F Veglio, M Porta, F M Grignolo, and T Y Wong Hypertensive retinopathy revisited: some answers, more questions Br. J. Ophthalmol., December 1, 2005; 89(12): 1646 - 1654. [Abstract] [Full Text] [PDF]