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3高血压病是部分眼病的潜在危险因素
3.1年龄相关性黄斑变性 AMD是发达国家≥65岁人群视力损害的最常见原因，主要表现为脉络膜新生血管形成或视网膜地图样萎缩。研究提示，高血压病与罹患AMD的危险性增加有关，收缩压升高与该患者10年内患AMD的危险性增加有关[3]。局部小动脉狭窄，HR的标志之一，与某些AMD体征的发生率相关[3]。心血管疾病的诸多危险因素（例如吸烟、颈动脉疾病和全身性炎症病灶的存在）也增加罹患AMD的危险[24,25]。AMD还与中风和心血管意外相关[25,26]。然而，特异的抗高血压药物和降低血压的治疗是否有助于防治AMD还有待证实。已有研究表明，抗高血压药物与患AMD的危险度无关[3]。
3.2青光眼 青光眼是以进行性视神经损害和视野缺损为特征的一组病变，是不可逆性致盲眼病，全世界青光眼患病人数已超过5千万。青光眼的主要危险因素是高眼压。高血压病很可能增加了青光眼发生和发展的危险。这一关联的病理生理机制已被提出[27]。首先，高血压病造成的直接微血管损伤可能使前部视神经的血供减少。其次，青光眼损害了后部睫状循环系统的自我调节，而高血压病可能进一步干扰了这一调节机制。第三，抗高血压治疗可能造成时段性低血压。特别是在夜间，时段性低血压可能减少视乳头血供，加重视神经损害。第四，与高血压相关的其他心血管危险因素（例如糖尿病和心血管疾病）可能影响视乳头的血流灌注。最后，全身血压情况与眼内压这一青光眼视神经损害的主要危险因素密切相关。然而，研究并未证实高血压与青光眼之间存在稳定的相关性。有研究发现二者存在横断面相关性[28]。另有报告称在控制了青光眼的主要危险因素（例如眼内压）之后，高血压病患者患青光眼的可能性比非高血压患者高50%[28]，且与青光眼的其他危险因素相比，高血压病是最普遍的危险因素，从公共健康的角度认识，高血压病可能比那些更为少见，但罹患青光眼的危险度高2～3倍的其他危险因素更具重要意义。尽管如此，前瞻性研究并未证明收缩压或舒张压与青光眼发病率之间存在相关性[29]。
在理解血压与青光眼的关系时，难点是区分血压对眼部的影响和血压与眼内压之差即灌注压对眼部的影响。有研究显示，低灌注压（低血压联合高眼压）相对于高血压病本身来说是一个更大的危险因素[3]。高血压病对于老年人来说是患青光眼的危险因素，但对年轻人并非如此，因为青年组患者罕见慢性视网膜微血管病变[30]。降血压药物治疗是否可以防止青光眼进展尚无定论。但在控制好眼压的同时更合理的调节控制血压可能有助于稳定青光眼的病情。
4研究方向和结论
高血压病在世界范围内有很高的患病率。鉴于高血压病对眼部有广泛的影响，多数学者认为高血压病患者均应接受眼科评价来检测HR及其他视网膜血管并发症，其中，II级HR患心血管疾病的危险性增加。今后尚待研究的问题有：首先，还没有标准化的HR分期方法既可应用于早期病变的评价，又有很好的重复性，并且能可靠预测心血管疾病。视网膜照相在检测I级HR时可能比检眼镜更精准，但该两项检查精确性的差异尚未经对照研究证实，从普及和方便的角度，仍建议用检眼镜进行常规检查。其次，高血压病的影响有种族和人种差异，我们期待研究在不同种族和人种中高血压病对眼部的影响有哪些不同。最后，还应该进一步研究并确认严格控制血压是否能够减少视力减退和全身病变的发生。总之，对高血压病眼部影响的认识有助于医生更合理适时的诊治高血压病及其靶器官损害。
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