Differential effects of antihypertensive treatment on the retinal microcirculation: an anglo-scandinavian cardiac outcomes trial substudy

Simon Thom, Christoph Stettler, Alice Stanton, Nicholas Witt, Robyn Tapp, Nish Chaturvedi, Sabin Allemann, Jamil Mayet, Peter Sever, Neil Poulter, Eoin O'Brien, Alun Hughes

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Changes in the retinal microcirculation are associated with hypertension and predict cardiovascular mortality. There are few data describing the impact of antihypertensive therapy on retinal vascular changes. This substudy of the Anglo-Scandinavian Cardiac Outcomes Trial compared the effects of an amlodipine-based regimen (373 patients) with an atenolol-based regimen (347 patients) on retinal microvascular measurements made from fundus photographs. The retinal photographs were taken at a stage in the trial when treatments were stable and blood pressure was well controlled. Amlodipine-based treatment was associated with a smaller arteriolar length:diameter ratio than atenolol-based treatment (13.32 [10.75 to 16.04] versus 14.12 [11.27 to 17.81], median [interquartile range]; P<0.01). The association remained significant after adjustment for age, sex, cholesterol, systolic and diastolic blood pressures, body mass index, smoking, and statin treatment. This effect appeared to be largely attributable to shorter retinal arteriolar segment lengths in the amlodipine-treated group and is best explained by the vasodilator effects of amlodipine causing the visible emergence of branching side vessels. Photographic assessment of the retinal vascular network may be a useful approach to evaluating microvascular structural responses in clinical trials of antihypertensive therapy.

Original languageEnglish
Pages (from-to)405-408
Number of pages4
Issue number2
Early online date15 Jun 2009
Publication statusPublished - Aug 2009
Externally publishedYes

Bibliographical note

Free access to article


  • Aged
  • Amlodipine/administration & dosage
  • Antihypertensive Agents/administration & dosage
  • Atenolol/administration & dosage
  • Cardiovascular Diseases/prevention & control
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension/complications
  • Linear Models
  • Male
  • Microcirculation/drug effects
  • Middle Aged
  • Multivariate Analysis
  • Probability
  • Prospective Studies
  • Retinal Diseases/drug therapy
  • Retinal Vessels/drug effects
  • Risk Assessment
  • Scandinavian and Nordic Countries
  • Severity of Illness Index
  • Treatment Outcome
  • United Kingdom


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