Choriocapillaris microvasculature dysfunction in systemic hypertension

Jacqueline Chua,Ecosse Lamoureux,Thu-Thao Le,Chi Li,Calvin Woon Loong Chin,Damon Wing Kee Wong,Bingyao Tan,Tien Yin Wong,Leopold Schmetterer,Anna C S Tan,Mengyuan Ke

doi:10.1038/s41598-021-84136-6

Abstract

We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71 hypertensive patients and determined possible correlations with BP and renal parameters. BP levels, serum creatinine and urine microalbumin/creatinine ratio (MCR) specimens were collected. The estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. The main outcome was choriocapillaris flow deficits (CFD) metrics (density, size and numbers). The CFD occupied a larger area and were fewer in number in the hypertensive patients with poor BP control (407 ± 10 µm2; 3260 ± 61) compared to the hypertensives with good BP control (369 ± 5 µm2; 3551 ± 41) and healthy controls (365 ± 11 µm2; 3581 ± 84). Higher systolic BP (β = 9.90, 95% CI, 2.86–16.93), lower eGFR (β = − 0.85; 95% CI, − 1.58 to − 0.13) and higher urine MCR (β = 1.53, 95% CI, 0.32–2.78) were associated with larger areas of CFD. Similar significant associations with systolic BP, eGFR and urine MCR were found with number of CFD. These findings highlight the potential role of choriocapillaris imaging using SS-OCTA as an indicator of systemic microvascular abnormalities secondary to hypertensive disease.

Highlights

We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71 hypertensive patients and determined possible correlations with blood pressure (BP) and renal parameters
We excluded 71 participants due to eye diseases, diabetes, and poor quality OCTA images and 112 participants were available for analysis, comprising of 41 healthy controls, 53 and 18 hypertensives with well and poor controlled BP, respectively (Supplementary Figure S1)
We show that individuals with uncontrolled systemic hypertension who had higher systolic BP or poorer kidney function had the most significant choriocapillaris flow deficits (CFD) compared to well-controlled hypertensives and normal controls, as measured by SS-OCTA

Summary

Introduction

We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71 hypertensive patients and determined possible correlations with BP and renal parameters. Similar significant associations with systolic BP, eGFR and urine MCR were found with number of CFD These findings highlight the potential role of choriocapillaris imaging using SS-OCTA as an indicator of systemic microvascular abnormalities secondary to hypertensive disease. Regardless of the mechanisms that initiate the rise of blood pressure (BP), extensive structural and functional changes in the systemic microvasculature is known to occur in many tissues in patients with hypertension[2] One such consequence of hypertension is the reduction in the density of the microvasculature (rarefaction) in various target organs such as the eyes and the kidneys[3].

Methods

Results

Conclusion