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

Jacqueline Chua, Calvin Woon Loong Chin, Jimmy Hong, Miao Li Chee, Thu-Thao Le, Daniel Shu Wei Ting, Tien Yin Wong, Leopold Schmetterer, Jacqueline Chua, Calvin Woon Loong Chin, Jimmy Hong, Miao Li Chee, Thu-Thao Le, Daniel Shu Wei Ting, Tien Yin Wong, Leopold Schmetterer

Abstract

Objective: Reduction in capillary density or rarefaction is a hallmark of essential hypertension. We measured the retinal capillary density using noninvasive optical coherence tomographic angiography (OCT-A) in adults with treated systemic hypertension and determined possible correlations with ambulatory blood pressure (BP) and renal parameters.

Methods: This observational cross-sectional study consisted of 153 normal eyes from 77 nondiabetic hypertensive adults [mean (SD) age, 58 (9) years; 49% women; 23% poorly controlled BP]. Data on 24-h ambulatory BP monitoring, serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. Retinal capillary density measured with the OCT-A (AngioVue) at superficial (SVP) and deep vascular plexuses (DVP). Linear regression was used to investigate the association of risk factors with capillary density.

Results: Retinal capillary density (percentage) at DVP was reduced in patients with poorly controlled BP (SBP = 148 ± 8 mmHg; 27.2 ± 13.0) compared with those with well controlled BP (SBP = 125 ± 9 mmHg; 34.7 ± 11.3). In the multivariable analysis, poorly controlled BP [β = -6.49, 95% confidence interval (CI), -12.39 to -0.59], higher SBP (β = -0.23, 95% CI -0.44 to -0.02) and lower eGFR (β = 6.42, 95% CI 1.25-11.60) were associated with sparser retinal capillary density. Systemic factors were not associated with capillary density at SVP (all P > 0.05).

Conclusion: 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.

Figures

FIGURE 1
FIGURE 1
Capillary density map of the macular region showing retinal microvasculature of participants with (a) poorly controlled blood pressure (less dense) and (b) well controlled blood pressure (more dense). (i) Capillary density extracted map with a circular (diameter of 1.0 mm centered on the fovea) measurement region defined. (ii) Capillary density color-coded map. (iii) Deep vascular plexus (slab boundary of 15–70 μm below the inner plexiform layer).
FIGURE 2
FIGURE 2
Identification of study participants. Of the 77 participants with systemic hypertension, 18 (23%) had poorly controlled blood pressure despite use of antihypertensive medications.
FIGURE 3
FIGURE 3
Scatterplot showing (a) negative correlation of retinal capillary density with 24-h ambulatory SBP and (b) positive correlation of retinal capillary density with estimated glomerular filtration rate among participants with systemic hypertension at deep vascular plexus. Pearson's correlation coefficients and P values shown indicate the strengths of the linear relationship between the variables.

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