微血管结构改变可能被认为是高血压介导的器官损伤的重要形式。使用局部侵入性技术（肌显微描记术）评估的皮下小动脉中管与管腔比率的增加可以预测心血管（CV）事件的发生。然而，尚不清楚采用非侵入性方法（自适应光学）评估的视网膜小动脉结构改变是否具有预后意义。 237 名受试者（平均年龄 58.7 ± 16.1 岁，年龄范围 13-89 岁；116该研究包括 65 名血压正常受试者 (27.4%) 和 172 名原发性高血压或原发性醛固酮增多症患者 (72.6%)。所有受试者均接受自适应光学技术对视网膜小动脉壁与管腔比率 (WLR) 的非侵入性评估。平均随访时间为 4.55 年后，对受试者进行重新评估，以评估临床事件（非 CV 和/或 CV 死亡或事件）的发生情况。研究人群中发生了 54 起事件：26 起为心脏病事件。脑血管事件（缺血性或出血性中风、心房颤动、心力衰竭、冠状动脉疾病、外周动脉疾病、心脏瓣膜病），其余为任何原因的死亡或肿瘤性疾病。发生事件的受试者年龄较大，视网膜小动脉的 WLR 显着大于未发生事件的受试者。根据 Kaplan-Mayer 生存曲线和多变量分析（Cox 比例风险模型），基线 WLR 高于人群中值 (0.28) 的患者的无事件生存率明显较差。在将分析限制于 CV 事件后，证据得到了证实。通过自适应光学评估的视网膜小动脉的结构改变可以预测总事件和 CV 事件。版权所有 © 2023 欧洲内科医学联合会。由 Elsevier B.V. 出版。保留所有权利。

Microvascular structural alterations may be considered an important form of hypertension-mediated organ damage. An increased media-to-lumen ratio of subcutaneous small arteries evaluated with locally invasive techniques (micromyography) predicts the development of cardiovascular (CV) events. However, it is not known whether retinal arteriole structural alterations evaluated with a noninvasive approach (Adaptive Optics) may have a prognostic significance.Two-hundred and thirty-seven subjects (mean age 58.7 ± 16.1 years, age range 13-89 years; 116 males) were included in the study: 65 normotensive subjects (27.4 %) and 172 patients with essential hypertension or primary aldosteronism (72.6 %). All subjects underwent a non-invasive evaluation of retinal arteriolar wall-to-lumen ratio (WLR) by Adaptive Optics. Subjects were re-evaluated after an average follow-up time of 4.55 years in order to assess the occurrence of clinical events (non CV and/or CV death or events).Fifty-four events occurred in the study population:26 were cardio-cerebrovascular events (ischemic or hemorragic stroke, atrial fibrillation, heart failure, coronary artery disease, peripheral artery disease, cardiac valvular disease) while the remaining were deaths for any cause, or neoplastic diseases. Subjects with events were older and had a WLR of retinal arterioles significantly greater than those without events. The event-free survival was significantly worse in those with a baseline WLR above the median value of the population (0.28) according to Kaplan-Mayer survival curves and multivariate analysis (Cox's proportional hazard model). The evidence was confirmed after restricting the analysis to CV events.Structural alterations of retinal arterioles evaluated by Adaptive Optics may predict total and CV events.Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.