Relationship of choroidal thickness with pulsatile hemodynamics in essential hypertensive patients

Mulè, Giuseppe; Vadalà, Maria; Sinatra, Nicola; Mancia, Ettore; Sorce, Alessandra; Geraci, Giulio; Carollo, Caterina; Castellucci, Massimo; Guarrasi, Giulia; Cillino, Salvatore; Cottone, Santina

doi:10.1111/jch.14196

Cited by 9 publications

(8 citation statements)

References 38 publications

(141 reference statements)

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“…Similar to what happens in the kidneys, arterial stiffness might predispose choroidal circulation to increased hemodynamic pressure, with consequent local damage and reduced ChT. In line with this concept, significant inverse relationships of ChT with PWV [ 70 ] as well as with aortic PP [ 76 ] have been reported.…”

Section: Retinal and Glomerular Vasculature: Two Sides Of The Same Coinmentioning

confidence: 87%

Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies

et al. 2022

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Hypertension is a major cardiovascular risk factor that is responsible for a heavy burden of morbidity and mortality worldwide. A critical aspect of cardiovascular risk estimation in hypertensive patients depends on the assessment of hypertension-mediated organ damage (HMOD), namely the generalized structural and functional changes in major organs induced by persistently elevated blood pressure values. The vasculature of the eye shares several common structural, functional, and embryological features with that of the heart, brain, and kidney. Since retinal microcirculation offers the unique advantage of being directly accessible to non-invasive and relatively simple investigation tools, there has been considerable interest in the development and modernization of techniques that allow the assessment of the retinal vessels’ structural and functional features in health and disease. With the advent of artificial intelligence and the application of sophisticated physics technologies to human sciences, consistent steps forward have been made in the study of the ocular fundus as a privileged site for diagnostic and prognostic assessment of diverse disease conditions. In this narrative review, we will recapitulate the main ocular imaging techniques that are currently relevant from a clinical and/or research standpoint, with reference to their pathophysiological basis and their possible diagnostic and prognostic relevance. A possible non pharmacological approach to prevent the onset and progression of retinopathy in the presence of hypertension and related cardiovascular risk factors and diseases will also be discussed.

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Section: Retinal and Glomerular Vasculature: Two Sides Of The Same Coinmentioning

confidence: 87%

Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies

et al. 2022

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“…155 Over time, increased pulsatility in penetrating small blood vessels as a result of conduit artery stiffening and increased pulse pressure induces microvascular injury leading to remodelling, endothelial dysfunction, and ischaemia as discussed earlier in this paper, and rarefaction of smaller arterioles and capillaries. 156 Mulè et al studied 158 consecutive hypertensive subjects and found choroidal thinning with higher 24-hour pulse pressure that reflects arterial stiffness. 156 Thus, choroidal hyperperfusion may be followed by injury resulting from both increased flow, 155 and enhanced pulsatility contributing to further injury.…”

Section: Hypertensive Choroidopathymentioning

confidence: 99%

“…156 Mulè et al studied 158 consecutive hypertensive subjects and found choroidal thinning with higher 24-hour pulse pressure that reflects arterial stiffness. 156 Thus, choroidal hyperperfusion may be followed by injury resulting from both increased flow, 155 and enhanced pulsatility contributing to further injury. This is followed by the effect of the myogenic reflex that induces vasoconstriction and impaired perfusion and tissue exchange, with enhanced oxidative stress in the vascular wall, all leading to microvascular rarefaction, reduced flow and choroidal thinning as a later expression of chronic hypertension.…”

Section: Hypertensive Choroidopathymentioning

confidence: 99%

“…This is followed by the effect of the myogenic reflex that induces vasoconstriction and impaired perfusion and tissue exchange, with enhanced oxidative stress in the vascular wall, all leading to microvascular rarefaction, reduced flow and choroidal thinning as a later expression of chronic hypertension. 156 Recently, Mulè et al studied 100 essential hypertensive patients (65 without CKD, and 35 in stages 1−3 CKD) and showed that subjects with CKD had thinner choroids, with choroidal thickness correlating positively with eGFR and negatively with urinary albumin excretion after accounting for age and other confounders. 157 This suggests a close relationship between changes in the choroidal circulation of the eye and the renal function, again emphasising choroidal thinning as a potential sign of generalized vascular injury in hypertension.…”

Section: Hypertensive Choroidopathymentioning

confidence: 99%

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Hypertensive eye disease

Cheung

Biousse

Keane

et al. 2022

Nat Rev Dis Primers

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Hypertensive eye disease includes a spectrum of pathological changes, the most wellknown being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (e.g., kidney disease) elsewhere in the body.Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence (AI), and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification.

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“…This hypothesis is confirmed by Mulé and coauthors in the present issue of Journal of Clinical Hypertension. 13 In this paper, Mulé explored choroidal thickness in 155 hypertensive patients undergoing a 24‐hour ambulatory blood pressure monitoring for the evaluation of central and brachial 24 hour‐pulse pressure. 14 Patients with a central pulse pressure > 35 mm Hg exhibited a thinner choroidal thickness.…”

Section: Introductionmentioning

confidence: 99%

Aortic pulsatility drives microvascular organ damage in essential hypertension: New evidence from choroidal thickness assessment

Bruno

Climie

2021

J of Clinical Hypertension

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Relationship of choroidal thickness with pulsatile hemodynamics in essential hypertensive patients

Cited by 9 publications

References 38 publications

Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies

Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies

Hypertensive eye disease

Aortic pulsatility drives microvascular organ damage in essential hypertension: New evidence from choroidal thickness assessment

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