Abstract
Microvascular disease and rarefaction are key pathological hallmarks of hypertension. The retina uniquely allows direct, non-invasive investigation of the microvasculature. Recently developed optical coherence tomography angiography now allows investigation of the fine retinal capillaries, which may provide a superior marker of overall vascular damage. This was a prospective cross-sectional study to collect retinal capillary density data on 300 normal eyes from 150 hypertensive adults, and to investigate possible associations with other organ damage markers. The average age of participants was 54 years and there was a greater proportion of males (85; 57%) than females. Multivariate, confounder adjusted linear regression showed that retinal capillary rarefaction in the parafovea was associated with increased pulse wave velocity (β = − 0.4, P = 0.04), log-albumin/creatinine ratio (β = − 0.71, P = 0.003), and with reduced estimated glomerular filtration rate (β = 0.04, P = 0.02). Comparable significant associations were also found for whole-image vascular-density, for foveal vascular-density significant associations were found with pulse wave velocity and estimated glomerular filtration rate only. Our results indicate that retinal capillary rarefaction is associated with arterial stiffness and impaired kidney function. Retinal capillary rarefaction may represent a useful and simple test to assess the integrated burden of hypertension on the microvasculature irrespective of current blood pressure levels.
Highlights
Microvascular disease and rarefaction are key pathological hallmarks of hypertension
These findings indicate that retinal capillary rarefaction in SVP is associated with arterial stiffness as measured by pulse wave velocity (PWV), and impaired kidney function as measured by estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio (ACR), independent of age, sex, diabetes and best practice blood pressure (BP) measures
The results from our study indicate that microvascular changes in the eye as assessed by retinal capillary density using Optical coherence tomographic angiography (OCT-A), are clearly associated with other well-established markers of hypertension mediated organ damage (HMOD) including arterial stiffness as measured by PWV, and impaired kidney function as assessed both by eGFR and ACR
Summary
Microvascular disease and rarefaction are key pathological hallmarks of hypertension. Developed optical coherence tomography angiography allows investigation of the fine retinal capillaries, which may provide a superior marker of overall vascular damage. This was a prospective crosssectional study to collect retinal capillary density data on 300 normal eyes from 150 hypertensive adults, and to investigate possible associations with other organ damage markers. The retina uniquely allows direct, non-invasive investigation of the microvasculature, providing a valuable window into the microvascular sequelae of hypertension. Optical coherence tomographic angiography (OCT-A) is a more recent ocular imaging technology that permits fast, non-invasive assessment of the retinal capillaries and blood flow in the retina (see Fig. 1). Recent investigations using OCT-A technology have reported reduced retinal capillary density in d iabetes[24] and uncontrolled h ypertension[25], while another study reported restoration of normal capillary density after treatment with carotid angioplasty and stenting[26]
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