Elevated blood pressure increases risk of proliferative diabetic retinopathy: a Mendelian randomization study_Chinese Journal of Ocular Fundus Diseases

Authors：

Su Gang ¹ , Liu Zhao ^1,2 ,  Cai Shanjun ¹

1. Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Guizhou Ophthalmology Hospital & Guizhou Branch of National Ophthalmology Clinical Research Center & Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi 563003, China;
2. Department of Clinical Medicine, The First Clinical College of Zunyi Medical University. Zunyi 563003, China;

Corresponding author：

Cai Shanjun, Email: caishanjun@163.com

Keywords：

Mendelian randomization; Systolic blood pressure; Diastolic blood pressure; Proliferative diabetic retinopathy

DOI：

10.3760/cma.j.cn511434-20230707-00301

Video：

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Objective Mendelian randomization (MR) was used to analyze the potential relationship between blood pressure and proliferative diabetic retinopathy (PDR). Methods Two-sample MR analysis was performed using summary statistics from genome-wide association studies. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were selected as the exposure, PDR as the outcome. The instrumental variable of SBP and DBP came from the publicly available data of the the UK Medical Research Council Comprehensive Epidemiology Unit and Neale Laboratory; the outcome data (8 681 cases in the case group, 204 208 cases in the control group, European population) are from the FinnGen database. Inverse variance weighting (IVW) and weighted median (WM) were used to analyze the potential relationships between SBP, DBP and PDR. Results MR analysis showed that IVW [SBP: odds ratio (OR)=1.36, 95% confidence interval (CI) 1.17-1.57, P=4.22E-05; DBP: OR=1.29, 95%CI 1.11-1.51, P=8.6E-04], WM (SBP: OR=1.33, 95%CI 1.07-1.66, P=0.009; DBP: OR=1.28, 95%CI=1.03-1.59, P=0.002). The results showed that elevated SBP and DBP increased the risk of PDR. Conclusion Blood pressure (SBP, DBP) change is positively correlated with the risk of PDR.

Citation： Su Gang, Liu Zhao, Cai Shanjun. Elevated blood pressure increases risk of proliferative diabetic retinopathy: a Mendelian randomization study. Chinese Journal of Ocular Fundus Diseases, 2024, 40(2): 142-147. doi: 10.3760/cma.j.cn511434-20230707-00301 Copy

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8.	Su Z, Wu Z, Liang X, et al. Diabetic retinopathy risk in patients with unhealthy lifestyle: a mendelian randomization study[J/OL]. Front Endocrinol (Lausanne), 2023, 13: 1087965[2023-01-17]. https://pubmed.ncbi.nlm.nih.gov/36733810/. DOI: 10.3389/fendo.2022.1087965.
9.	Cai J, He L, Wang H, et al. Genetic liability for prescription opioid use and risk of cardiovascular diseases: a multivariable mendelian randomization study[J]. Addiction, 2022, 117(5): 1382-1391. DOI: 10.1111/add.15767.
10.	Hemani G, Zheng J, Elsworth B, et al. The MR-Base platform supports systematic causal inference across the human phenome[J/OL]. Elife, 2018, 7: e34408[2018-05-30]. https://pubmed.ncbi.nlm.nih.gov/29846171/. DOI: 10.7554/eLife.34408.
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14.	Pierce BL, Burgess S. Efficient design for mendelian randomization studies: subsample and 2-sample instrumental variable estimators[J]. Am J Epidemiol, 2013, 178(7): 1177-1184. DOI: 10.1093/aje/kwt084.
15.	Bowden J, Davey Smith G, Haycock PC, et al. Consistent estimation in mendelian randomization with some invalid instruments using a weighted median estimator[J]. Genet Epidemiol, 2016, 40(4): 304-314. DOI: 10.1002/gepi.21965.
16.	Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909.
17.	Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review[J]. Clin Exp Ophthalmol, 2016, 44(4): 260-277. DOI: 10.1111/ceo.12696.
18.	Amarnath S, Starr A, Chukkalore D, et al. The association between gastroesophageal reflux disease and non-small cell lung cancer: a retrospective case-control study[J]. Gastroenterology Res, 2022, 15(4): 173-179. DOI: 10.14740/gr1537.
19.	Bhargava M, Ikram MK, Wong TY. How does hypertension affect your eyes?[J]. J Hum Hypertens, 2012, 26(2): 71-83. DOI: 10.1038/jhh.2011.37.
20.	Pournaras CJ, Rungger-Brändle E, Riva CE, et al. Regulation of retinal blood flow in health and disease[J]. Prog Retin Eye Res, 2008, 27(3): 284-330. DOI: 10.1016/j.preteyeres.2008.02.002.
21.	Sun C, Wang JJ, Mackey DA, et al. Retinal vascular caliber: systemic, environmental, and genetic associations[J]. Surv Ophthalmol, 2009, 54(1): 74-95. DOI: 10.1016/j.survophthal.2008.10.003.
22.	Kawasaki R, Cheung N, Wang JJ, et al. Retinal vessel diameters and risk of hypertension: the multiethnic study of atherosclerosis[J]. J Hypertens, 2009, 27(12): 2386-2393. DOI: 10.1097/HJH.0b013e3283310f7e.
23.	Katsi V, Marketou M, Vlachopoulos C, et al. Impact of arterial hypertension on the eye[J]. Curr Hypertens Rep, 2012, 14(6): 581-590. DOI: 10.1007/s11906-012-0283-6.
24.	Zhang HN, Xu QQ, Thakur A, et al. Endothelial dysfunction in diabetes and hypertension: role of microRNAs and long non-coding RNAs[J]. Life Sci, 2018, 213: 258-268. DOI: 10.1016/j.lfs.2018.10.028.
25.	Tan TE, Wong TY. Diabetic retinopathy: Looking forward to 2030[J/OL]. Front Endocrinol (Lausanne), 2023, 13: 1077669[2023-01-09]. https://pubmed.ncbi.nlm.nih.gov/36699020/. DOI: 10.3389/fendo.2022.1077669.

1. Lee JH, Kim YA, Lee Y, et al. Association between interarm blood pressure differences and diabetic retinopathy in patients with type 2 diabetes[J/OL]. Diab Vasc Dis Res, 2020, 17(7): 1479164120945910[2020-07-01]. https://pubmed.ncbi.nlm.nih.gov/32746630/. DOI: 10.1177/1479164120945910.
2. Sardarinia M, Asgari S, Hizomi Arani R, et al. Incidence and risk factors of severe non-proliferative/proliferative diabetic retinopathy: more than a decade follow up in the tehran lipids and glucose study[J]. J Diabetes Investig, 2022, 13(2): 317-327. DOI: 10.1111/jdi.13647.
3. Roy MS, Affouf M. Six-year progression of retinopathy and associated risk factors in African American patients with type 1 diabetes mellitus: the New Jersey 725[J]. Arch Ophthalmol, 2006, 124(9): 1297-1306. DOI: 10.1001/archopht.124.9.1297.
4. Lee CC, Hsing SC, Lin YT, et al. The importance of close follow-up in patients with early-grade diabetic retinopathy: a Taiwan population-based study grading via deep learning model[J/OL]. Int J Environ Res Public Health, 2021, 18(18): 9768[2021-09-16]. https://pubmed.ncbi.nlm.nih.gov/34574686/. DOI: 10.3390/ijerph18189768.
5. Perais J, Agarwal R, Evans JR, et al. Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy[J/OL]. Cochrane Database Syst Rev, 2023, 2(2): CD013775[2023-02-22]. https://pubmed.ncbi.nlm.nih.gov/36815723/. DOI: 10.1002/14651858.CD013775.pub2.
6. Boef AG, Dekkers OM, le Cessie S. Mendelian randomization studies: a review of the approaches used and the quality of reporting[J]. Int J Epidemiol, 2015, 44(2): 496-511. DOI: 10.1093/ije/dyv071.
7. Lee K, Lim CY. Mendelian randomization analysis in observational epidemiology[J]. J Lipid Atheroscler, 2019, 8(2): 67-77. DOI: 10.12997/jla.2019.8.2.67.
8. Su Z, Wu Z, Liang X, et al. Diabetic retinopathy risk in patients with unhealthy lifestyle: a mendelian randomization study[J/OL]. Front Endocrinol (Lausanne), 2023, 13: 1087965[2023-01-17]. https://pubmed.ncbi.nlm.nih.gov/36733810/. DOI: 10.3389/fendo.2022.1087965.
9. Cai J, He L, Wang H, et al. Genetic liability for prescription opioid use and risk of cardiovascular diseases: a multivariable mendelian randomization study[J]. Addiction, 2022, 117(5): 1382-1391. DOI: 10.1111/add.15767.
10. Hemani G, Zheng J, Elsworth B, et al. The MR-Base platform supports systematic causal inference across the human phenome[J/OL]. Elife, 2018, 7: e34408[2018-05-30]. https://pubmed.ncbi.nlm.nih.gov/29846171/. DOI: 10.7554/eLife.34408.
11. Burgess S, Thompson SG. Interpreting findings from mendelian randomization using the MR-Egger method[J]. Eur J Epidemiol, 2017, 32(5): 377-389. DOI: 10.1007/s10654-017-0255-x.
12. Bowden J, Del Greco MF, Minelli C, et al. Assessing the suitability of summary data for two-sample mendelian randomization analyses using MR-Egger regression: the role of the I2 statistic[J]. Int J Epidemiol, 2016, 45(6): 1961-1974. DOI: 10.1093/ije/dyw220.
13. Bowden J, Davey Smith G, Burgess S. Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression[J]. Int J Epidemiol, 2015, 44(2): 512-525. DOI: 10.1093/ije/dyv080.
14. Pierce BL, Burgess S. Efficient design for mendelian randomization studies: subsample and 2-sample instrumental variable estimators[J]. Am J Epidemiol, 2013, 178(7): 1177-1184. DOI: 10.1093/aje/kwt084.
15. Bowden J, Davey Smith G, Haycock PC, et al. Consistent estimation in mendelian randomization with some invalid instruments using a weighted median estimator[J]. Genet Epidemiol, 2016, 40(4): 304-314. DOI: 10.1002/gepi.21965.
16. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909.
17. Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review[J]. Clin Exp Ophthalmol, 2016, 44(4): 260-277. DOI: 10.1111/ceo.12696.
18. Amarnath S, Starr A, Chukkalore D, et al. The association between gastroesophageal reflux disease and non-small cell lung cancer: a retrospective case-control study[J]. Gastroenterology Res, 2022, 15(4): 173-179. DOI: 10.14740/gr1537.
19. Bhargava M, Ikram MK, Wong TY. How does hypertension affect your eyes?[J]. J Hum Hypertens, 2012, 26(2): 71-83. DOI: 10.1038/jhh.2011.37.
20. Pournaras CJ, Rungger-Brändle E, Riva CE, et al. Regulation of retinal blood flow in health and disease[J]. Prog Retin Eye Res, 2008, 27(3): 284-330. DOI: 10.1016/j.preteyeres.2008.02.002.
21. Sun C, Wang JJ, Mackey DA, et al. Retinal vascular caliber: systemic, environmental, and genetic associations[J]. Surv Ophthalmol, 2009, 54(1): 74-95. DOI: 10.1016/j.survophthal.2008.10.003.
22. Kawasaki R, Cheung N, Wang JJ, et al. Retinal vessel diameters and risk of hypertension: the multiethnic study of atherosclerosis[J]. J Hypertens, 2009, 27(12): 2386-2393. DOI: 10.1097/HJH.0b013e3283310f7e.
23. Katsi V, Marketou M, Vlachopoulos C, et al. Impact of arterial hypertension on the eye[J]. Curr Hypertens Rep, 2012, 14(6): 581-590. DOI: 10.1007/s11906-012-0283-6.
24. Zhang HN, Xu QQ, Thakur A, et al. Endothelial dysfunction in diabetes and hypertension: role of microRNAs and long non-coding RNAs[J]. Life Sci, 2018, 213: 258-268. DOI: 10.1016/j.lfs.2018.10.028.
25. Tan TE, Wong TY. Diabetic retinopathy: Looking forward to 2030[J/OL]. Front Endocrinol (Lausanne), 2023, 13: 1077669[2023-01-09]. https://pubmed.ncbi.nlm.nih.gov/36699020/. DOI: 10.3389/fendo.2022.1077669.

Chinese Journal of Ocular Fundus Diseases

Elevated blood pressure increases risk of proliferative diabetic retinopathy: a Mendelian randomization study

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