Abstract
Background. Hypertension (HTN) is a preventable risk factor for morbidity and mortality worldwide. Hypertensive retinopathy (HR), its ocular complication, is characterized by progressive metabolic disorders and structural damage of the retina. Lipids play an essential role in retina homeostasis, so an alteration of lipid metabolism specific for HTN may be of great significance in the development of hypertensive retinal injury. The study aimed to investigate the association between HR, traditional lipid biomarkers changes, and the atherogenic index, as well as to highlight a possible role of lipid metabolism markers in HR diagnosis and prognosis. Methods. A total of 90 hypertensive patients from the Republic of Moldova, admitted to the Ovisus Medical Center, Chisinau, Republic of Moldova, for a vision check and firstly diagnosed with HR were recruited in our study. The enrolment period is between February 2018 and December 2019. They were divided into three groups based on fundoscopy, using Keith-Wagner-Barker grading system of HR—GI: 36 patients; GII: 35 patients; GIII: 19 patients. The level of serum lipids: triglycerides, total cholesterol, LDL-Chol, and HDL-Chol was determined, followed by the calculation of the atherogenic index of plasma. Results are displayed as the median and interquartile range (IQR). Kolmogorov-Smirnov and Shapiro-Wilk normality tests were used, followed by Levene’s homogeneity of variance test. The groups were compared using the non-parametric Kruskal-Wallis and Mann-Whitney tests. The Spearman correlation coefficient was calculated (SPSS 23.0): p Results. It was attested a statistically significant increase of serum total cholesterol levels between the groups as the HR advanced (p = 0.017). In paired group comparisons, the total cholesterol level in GII significantly enhanced compared to GI 5.63 (IQR 0.69) mM/L vs. 5.49 (IQR 0.51) mM/L, p = 0.05 and in GIII compared to GI 5.76 (IQR 0.82) μM/L vs. 5.49 (IQR 0.51) mM/L, p = 0.04, showing a significant weak positive correlation with the degree of HR (r = 0.292**, p = 0.005). A resembled tendency to increase was highlighted also in serum TAG levels between groups (p = 0.061), with a significant weak and positive correlation with the degree of HR (r = 0.249*, p = 0.018). The results for HDL-Chol, LDL-Chol and atherogenic index were insignificant. Conclusion. The study revealed statistically conclusive changes associated with the HR degree of the TAG and total cholesterol levels and the absence of changes in plasma lipoprotein content—LDL-Chol and HDL-Chol. Extended research is mandatory to conclude the role of lipid metabolism in the advancement of HR and to ascertain the potential diagnostic importance of the presented lipid status changes.
Highlights
The global burden of hypertension (HTN) exceeds 1.5 billion people, being at the same time, the most significant but preventable risk factor for disability or even death caused by cardiovascular diseases [1] [2] [3].Both the structure and the function of the vasculature of the eye are affected by the continuous increase of blood pressure
The study revealed statistically conclusive changes associated with the Hypertensive retinopathy (HR) degree of the TAG and total cholesterol levels and the absence of changes in plasma lipoprotein content—LDL-Chol and HDL-Chol
Observational study was done on a representative sample of patients with primary hypertension with HR, that came for a primary random check at Ovisus Ophthalmological Medical Center, during the period February 2018-December 2019 and at whom in the first time was established the diagnosis of HR, by an extensive ophthalmological consult, that included the ascertainty of visual acuity, autorefracto-keratometry, perimetry, anterior and fundus biomicroscopy, ultrasonography, tonometry, gonioscopy, optical coherence tomography (OCT) of the macular area and the papilla of the optic nerve
Summary
The global burden of hypertension (HTN) exceeds 1.5 billion people, being at the same time, the most significant but preventable risk factor for disability or even death caused by cardiovascular diseases [1] [2] [3]. Both the structure and the function of the vasculature of the eye are affected by the continuous increase of blood pressure. It was attested a statistically significant increase of serum total cholesterol levels between the groups as the HR advanced (p = 0.017).
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