Hypertension Clinical Trial
Official title:
Hypertension Related Damage to the Microcirculation in South Asian: Emergence,Predictive Power and Reversibility
Damage to very small blood vessels is a consequence, but can also precede high blood pressure. Such damage, measured by disturbances in the vessels in the retina (back of the eye) is a strong predictor of heart disease and stroke. South Asian people have one of the highest rates of hypertension in the world (30% in adults). In Pakistan, this is usually severe, undetected and untreated. The Wellcome Trust has already funded a study of blood pressure control in adults and children in this population. We propose a substudy, taking photographs of the retina and making measurements of the vessels, to determine whether such blood pressure related changes occur at an early age in young children with a family history of high blood pressure compared to those without, whether such changes predict an increase in blood pressure over time, and whether, in adults, such changes can be reversed by blood pressure treatment. The hypothesis of our study is: young offspring of South Asian people with hypertension have a disturbed microcirculation, as assessed by abnormalities of retinal vessels, compared to offspring of normotensive parents. Our 2nd hypothesis is: Abnormal retinal vascular geometry will improve proportionately to achieved reductions in BP.
Background
The role of the microcirculation is increasingly being recognized in the etiopathogenesis of
cardiovascular disease. Delays in this recognition are in part due to the difficulty of
studying the microcirculation non-invasively, in large numbers of individuals. Retinal
vessels provide an easily accessible “window” to the microcirculation. Abnormalities of the
retinal vasculature have been shown to be associated with cardiovascular risk factors and
all cause mortality. Non-invasive assessment of the retinal circulation presents a valuable
opportunity to study the structure and function of the microvasculature
Aims of the project
To compare geometry of retinal microvasculature of 1) hypertensive vs normotensive adults,
2) children aged 10 to 14 years of hypertensive parent (test group) versus normotensive
parent (control group), and, 3) to assess the impact of blood pressure lowering on these
changes over 2 years.
Primary outcome would be abnormal retinal geometry defined as the composite outcome of a)
abnormal arteriolar length: diameter ratios (a measure of relative arteriolar narrowing), b)
narrowed branching angles (an indicator of arteriolar rarefaction), or c) disturbed junction
exponents (a marker of endothelial dysfunction.
Significance of the study
If successful, this work could be extended to address future questions, including the
predictive value of these abnormalities for development of diabetes and hypertension as well
as CVD; to explore further the role of microvascular disturbances in disease etiology, and
to assess the impact of drug therapy on these abnormalities and their relationship to
outcomes in the South Asian population
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Factorial Assignment, Masking: Single Blind, Primary Purpose: Prevention
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