New Methodological Approach in the Analysis of Bulbar Conjunctival Biomicroscopy Data in Young Patients with Hypertension Stages I and II Depending on Smoking Status

Introduction. Our earlier studies have shown the negative effect of smoking and the positive effect of smoking cessation on the «classic» parameters of the microcirculatory bed (MCB). In this new study in young outpatients, we decided, in addition to the «classic» microcirculatory (MC) parameters analyzed earlier, to propose «new» ones and test their diagnostic significance, which was the purpose of this study. Materials and methods. We examined 171 outpatients (20–44 years old) with hypertension (HT) stages I/II. All were divided into 3 groups: Group 1 – those who stopped smoking (n=55), Group 2 – smokers (n=66), Group 3 – never smokers (n=50). The duration of HT in those who had stopped smoking was 3.0 (1.0; 7.0) years, in smokers – 3.0 (1.5; 10.0) years, in never smokers – 6.5 (2.0; 10.0) years. MC was studied by direct biomicroscopy of bulbar conjunctival vessels. The following «classic» parameters were assessed: the average diameter of arterioles, venules, capillaries, arteriole-venule ratio (AVR), the number of capillaries per 1 mm² of conjunctival surface, and «new» ones: the total number of arteriole-venule pairs (AVP), the number of normal and narrow AVPs, and the percentage of AVPs with low AVR. Results. The total number of AVPs was the lowest in the group of smokers (24 pairs), the highest in those who never smoked (30 pairs), and intermediate in the group of those who quit smoking (27 pairs). The number of narrow AVPs and the percentage of narrow AVPs were statistically significantly higher in the group of smokers (18 pairs and 66.7 %, respectively (p < 0.05 compared to non-smokers (13 pairs and 52.4 %, respectively, for the number of narrow AVPs and the percentage of narrow AVPs) and those who quit smoking (10 pairs and 48.6 %, respectively)), no significant differences were found between the latter. Conclusion. The diagnostic significance of «new» MC parameters is shown: the total number of AVPs, the number of normal and narrow AVPs and the percentage of narrow AVPs demonstrating an increase in total peripheral vascular resistance (TPVR) in patients with HT regardless of smoking status and the additional negative impact of smoking on resistive vessels.

1. Korneeva NV. Effect of smoking cessation on the parameters of microcirculation in arterial hypertension. Kazan medical journal. 2019;100 (3):402-409. (In Russ.)]. https://doi.org/10.17816/KMJ2019-402.

2. Korneeva NV. Influence of smoking status on vascular permeability and microcirculation in healthy young individuals, middle-age patients with arterial hypertension and coronary artery disease. Russian Journal of Preventive Medicine. 2024;27 (3):26 31. (In Russ.). https://doi.org/10.17116/profmed20242703126.

3. Korneeva NV, Leonov VP, Zhmerenetsky KV. Conjunctival biomicroscopy: methodology of analysis. Khabarovsk: FESMU publishing; 2020. (In Russ.).

4. Kozlov VI. Kapilljaroskopija v klinicheskoj praktike: monografija. M.: Prakticheskaja medicina, 2015. 232 s. (In Russ.).

5. Streltsova NN, Vasiliev AP. The influence of smoking on the functional state of microcirculation according to laser doppler flowmetry and clinical anamnestic data of patients with arterial hypertension. Lazernaya medicina. 2020;24 (4):24-31. (In Russ.). https://doi.org/10.37895/2071-8004-2020-24-4-24-31.

6. Shcherbakova K, Yasenovets M, Barsukov A. Hypertensive angiopathy of the retina as a target organ and a marker of cardiovascular risk. Vrach. 2018;29 (10):18-21. (In Russ.). https://doi.org/10.29296/25877305-2018-10-05.

7. Semenova NS, Akopyan VS, Filonenko IV. Retinal vessels caliber assessment in patients with arterial hypertension. Ophthalmology in Russia. 2012;9 (1):58-62. (In Russ.). https://doi.org/10.18008/1816-5095-2012-1-58-62.

8. Semenova NS, Akopyan VS, Rodin AS. Progress in measurement of retinal vascular caliber. Review. Ophthalmology in Russia. 2012;9 (1):14-17. (In Russ.). https://doi.org/10.18008/1816-5095-2012-1-14-17.

9. Stepushina OA. Caliber measurement of retinal blood vessels with the usage of adaptive optics and fluorescence angiography in patients with refractive errors. Kazanskij medicinskij zhurnal. 2011;92 (6):865-867. (In Russ.).

10. Carey RM. Pathophysiology of primary hypertension. In: Handbook of physiology: Microcirculation. Eds.: R. F. Tuma, W. N. Duran, R. Ley. Amsterdam-Tokyo, 2008:794- 896. https://doi.org/10.1016/b978–0–12–374530–9.00020–6.

11. Shkarin VV, Lozhakova MV. Narushenija mikrocirkuljacii pri jessencial’noj arterial’noj gipertenzii: klinicheskie i gemodinamicheskie aspekty. Medicinskij al’manah. 2012; (20)1:179-183. (In Russ.).

12. Smeda JS, Lee RM, Forrest JB. Structural and reactivity alterations of the renal vasculature of spontaneously hypertensive rats prior to and during established hypertension. Circ. Res. 1988;63:518-533. https://doi.org/10.1161/01.res.63.3.518.

13. Mulvany MJ. Vascular remodelling of resistance vessels: can we define this? Cardiovascular Research. 1999;41(1): 9-13. https://doi.org/10.1016/S0008-6363(98)00289-2.

14. Malyutina SK, Direev AO, Munz IV, et al. Relationship of retinal vascular caliber with age and cardiometabolic diseases in the population over 50 years of age. Russian Annals of Ophthalmology. Vestnik oftal’mologii. 2022;138 (5):14-21. (In Russ.). https://doi.org/10.17116/oftalma202213805114.

15. Von Hanno T, Bertelsen G, Sjolie A. et al. Retinal vascular calibers are significantly associated with cardiovascular risk factors: the Tromso Eye Study.Acta Ophthalmol. 2014;92 (1):40-6. https://doi.org/10.1111/aos.12102.

16. Kiseleva TN, Lugovkina KV, Makukhina VV. Optical coherence tomography angiography of the anterior segment of the eye in assessment of microcirculation in ocular pathology. Regional hemodynamics and microcirculation. 2023;22 (2):11-15. (In Russ.). https://doi.org/10.24884/1682-6655-2023-22-2-11-15.