Impact of hypertension on retinal capillary microvasculature using optical coherence tomographic angiography

Abstract

In adults with treated systemic hypertension, retinal capillary density reduced with higher BP and poorer eGFR. These findings highlight the potential role of OCT-A to study early microvascular changes because of systemic hypertension.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.

The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

“…A study of Asian patients with hypertension found that those with poor BP control (assessed by 24-hour ambulatory monitoring) had a lower deep capillary plexus vessel density than did those with optimal BP control. 110 These groups were well matched in terms of age, sex, CVD risk factors, and renal function (mean eGFR w90 ml/min per 1.73 m 2 ), but the poorly controlled group had higher microalbuminuria. 110 In adjusted analyses, suboptimal BP control, increasing BP, and worsening eGFR were associated with worse capillary rarefaction.…”

“…110 These groups were well matched in terms of age, sex, CVD risk factors, and renal function (mean eGFR w90 ml/min per 1.73 m 2 ), but the poorly controlled group had higher microalbuminuria. 110 In adjusted analyses, suboptimal BP control, increasing BP, and worsening eGFR were associated with worse capillary rarefaction. 110 An Italian study extended these findings by using OCT-A in 120 hypertensive patients with and without CKD to report a lower vessel density in both superficial and deep capillary plexuses in those with CKD.…”

“…110 In adjusted analyses, suboptimal BP control, increasing BP, and worsening eGFR were associated with worse capillary rarefaction. 110 An Italian study extended these findings by using OCT-A in 120 hypertensive patients with and without CKD to report a lower vessel density in both superficial and deep capillary plexuses in those with CKD. 134 The inclusion of patients with more severe renal impairment and higher proteinuria in this study 134 may explain the more extensive retinal vessel rarefaction seen as compared with the Singapore study.…”

“…96 Another recent study included patients with more advanced CKD and found a consistent relationship between lower eGFR, higher protein leak, and a thinner choroid. 110 The differences in OCT metrics between CKD, hypertension, and health, as well as their associations with CKD severity, provide the initial evidence of the potential of OCT to identify and stratify individuals at increased CVD risk. Whether these metrics reflect systemic microvascular damage better than standard tools should be tested in future studies.…”

Early retinal microvascular abnormalities in patients with chronic kidney disease

“…Prior studies showed that both ACEI/ARB and calcium channel blockers may improve the retinal arteriolar narrowing and capillary rarefaction in hypertensive patients . The benefit of anti‐hypertensive drugs may have resulted either from better‐controlled BP or from other pharmacological effects independent of the BP lowering effect. For an example, a localized RAS had been found within the eye, such as in retinal microvasculature, Müller cells, and ganglion cells .…”