Association of Hypertension Defined by the 2017 ACC/AHA Guideline and Choroidal Thickness Changes in Type 2 Diabetes: A 2-Year Longitudinal Study

Abstract

Purpose To explore the longitudinal association between hypertension (HTN) defined by the 2017 American College of Cardiology (ACC)/ American Heart Association (AHA) blood pressure (BP) guideline and choroidal thickness (CT) changes among patients with type 2 diabetes.Methods This prospective cohort study included patients aged 30 to 80 years in the Guangzhou Diabetic Eye Study. BP categories were defined based on the 2017 ACC/AHA guideline as non-HTN, stage 1-HTN and stage 2-HTN. Macular and parapapillary CT were measured using swept-source optical coherence tomography (SS-OCT) device. The decline rates of macular and parapapillary CT over time were analyzed through mixed linear regression models. The associations between HTN and the decline rate of both macular and parapapillary CT were assessed using mixed linear regression analysis.Results A total of 803 patients with diabetes were enrolled in the study. Compared with none-HTN group, stage 2-HTN group showed significantly thinner macular and parapapillary CT at each visit (all P < 0.05). After adjusting multiple confounding factors, the stage 2-HTN group yielded significantly decreased rate of CT thinning in the macular area (coefficient [coef]=-9.88µm/year; 95% confidence intervals [CI], -16.24 to -3.51; P = 0.002), but not parapapillary area (coef=-0.54µm/year; 95% CI, -5.47 to 4.39; P = 0.830). Further stratified analyses showed that participants with stage 2-HTN had faster decline rates of macular CT in groups of males (coef=-15.41µm/year, 95% CI -25.72 to -5.10; P = 0.03), BMI > 25 kg/m2(coef=-14.54µm/year, 95% CI -24.12 to -4.96; P = 0.03), duration < 10 years (coef=-11.86µm/year, 95% CI -20.60 to -3.11; P = 0.08), and HbA1c > 6.5% (coef=-11.15µm/year, 95% CI -18.67 to -3.65; P = 0.04).Conclusion Stage 2-HTN is parallel with the progression of CT loss in the macular but not parapapillary area among patients with diabetes. Regular BP monitoring for this population may contribute to early screening and identification of macular damage.