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

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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.

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Most cited references 46

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A review of optical coherence tomography angiography (OCTA)

Talisa de Carlo, André Romano, Nadia K. Waheed … (2015)

Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds. This is a nascent technology with a potential wide applicability for retinal vascular disease. At present, level 1 evidence of the technology’s clinical applications doesn’t exist. In this paper, we introduce the technology, review the available English language publications regarding OCTA, and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases. OCTA is quick and non-invasive, and provides volumetric data with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. Its current limitations include a relatively small field of view, inability to show leakage, and proclivity for image artifact due to patient movement/blinking. Published studies hint at OCTA’s potential efficacy in the evaluation of common ophthalmologic diseases such age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma. OCTA can detect changes in choroidal blood vessel flow and can elucidate the presence of choroidal neovascularization (CNV) in a variety of conditions but especially in AMD. It provides a highly detailed view of the retinal vasculature, which allows for accurate delineation of the foveal avascular zone (FAZ) in diabetic eyes and detection of subtle microvascular abnormalities in diabetic and vascular occlusive eyes. Optic disc perfusion in glaucomatous eyes is notable as well on OCTA. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.

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Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3.

(2000)

To investigate possible risk factors for age-related macular degeneration (AMD) in participants in the Age-Related Eye Disease Study (AREDS). Case-control study. Of the 4757 persons enrolled in AREDS, 4519 persons aged 60 to 80 years were included in this study. The lesions associated with AMD ranged from absent in both eyes to advanced in one eye. Stereoscopic color fundus photographs of the macula were used to place participants into one of five groups, based on the frequency and severity of lesions associated with AMD. Participants with fewer than 15 small drusen served as the control group. Staged model building techniques were used to compare each of the four case groups with the control group. Increased age was a consistent finding of all four of the case groups compared with the control group, and all the following associations were age adjusted. Persons with either intermediate drusen, extensive small drusen, or the pigment abnormalities associated with AMD (group 2) were more likely to be female, more likely to have a history of arthritis, and less likely to have a history of angina. Persons with one or more large drusen or extensive intermediate drusen (group 3) were more likely to use hydrochlorothiazide diuretics and more likely to have arthritis. Hypertension, hyperopia, presence of lens opacities, and white race were also found more frequently in this group as well as in persons with neovascular AMD (group 5). Only persons in group 5 were more likely to have an increased body mass index, whereas persons with geographic atrophy (group 4) as well as those in groups 3 and 5 were more likely to have completed fewer years in school or to be smokers. Those with geographic atrophy were also more likely to use thyroid hormones and antacids. Our findings for smoking and hypertension, which have been noted in previous studies, suggest that two important public health recommendations, the avoidance of smoking and the prevention of hypertension, may reduce the risk of developing AMD. Other associations, such as those for hyperopia, lens opacities, less education, female gender, increased body mass index, and white race, which have been noted in other studies, are also seen in the AREDS population. The increased use of thyroid hormones and antacids in persons with geographic atrophy and the increased likelihood of arthritis or hydrochlorothiazide use in persons with one or more large drusen or extensive intermediate drusen have not been previously reported and need additional investigation.

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Optical Coherence Tomography Angiography Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes

Adeleh Yarmohammadi, Linda M. Zangwill, Alberto Diniz Filho … (2016)

Purpose The purpose of this study was to compare retinal nerve fiber layer (RNFL) thickness and optical coherence tomography angiography (OCT-A) retinal vasculature measurements in healthy, glaucoma suspect, and glaucoma patients. Methods Two hundred sixty-one eyes of 164 healthy, glaucoma suspect, and open-angle glaucoma (OAG) participants from the Diagnostic Innovations in Glaucoma Study with good quality OCT-A images were included. Retinal vasculature information was summarized as a vessel density map and as vessel density (%), which is the proportion of flowing vessel area over the total area evaluated. Two vessel density measurements extracted from the RNFL were analyzed: (1) circumpapillary vessel density (cpVD) measured in a 750-μm-wide elliptical annulus around the disc and (2) whole image vessel density (wiVD) measured over the entire image. Areas under the receiver operating characteristic curves (AUROC) were used to evaluate diagnostic accuracy. Results Age-adjusted mean vessel density was significantly lower in OAG eyes compared with glaucoma suspects and healthy eyes. (cpVD: 55.1 ± 7%, 60.3 ± 5%, and 64.2 ± 3%, respectively; P < 0.001; and wiVD: 46.2 ± 6%, 51.3 ± 5%, and 56.6 ± 3%, respectively; P < 0.001). For differentiating between glaucoma and healthy eyes, the age-adjusted AUROC was highest for wiVD (0.94), followed by RNFL thickness (0.92) and cpVD (0.83). The AUROCs for differentiating between healthy and glaucoma suspect eyes were highest for wiVD (0.70), followed by cpVD (0.65) and RNFL thickness (0.65). Conclusions Optical coherence tomography angiography vessel density had similar diagnostic accuracy to RNFL thickness measurements for differentiating between healthy and glaucoma eyes. These results suggest that OCT-A measurements reflect damage to tissues relevant to the pathophysiology of OAG.

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Author and article information

Journal

Journal ID (nlm-ta): J Hypertens

Journal ID (iso-abbrev): J. Hypertens

Journal ID (publisher-id): JHYPE

Title: Journal of Hypertension

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 0263-6352

ISSN (Electronic): 1473-5598

Publication date (Print): March 2019

Publication date (Electronic): 14 August 2018

Volume: 37

Issue: 3

Pages: 572-580

Affiliations

[a ]Singapore Eye Research Institute, Singapore National Eye Centre

[b ]Academic Clinical Program, Duke-NUS Medical School

[c ]National Heart Research Institute Singapore, National Heart Centre Singapore

[d ]Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System

[e ]Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore

[f ]Department of Clinical Pharmacology

[g ]Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria

Author notes

Correspondence to Professor Leopold Schmetterer, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore 169856. Tel: +65 65761702; fax: +65 6225 2568; e-mail: leopold.schmetterer@ 123456seri.com.sg

Article

Publisher ID: JH-D-18-00576

DOI: 10.1097/HJH.0000000000001916

PMC ID: 6365272

PubMed ID: 30113530

SO-VID: 1bf5d088-b028-4f61-9d76-ad6581cc3d74

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 19 June 2018

Date accepted : 29 July 2018

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Keywords: ambulatory blood pressure monitoring,blood pressure,hypertension,optical coherence tomographic angiography,renal function,retina

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Keywords: ambulatory blood pressure monitoring, blood pressure, hypertension, optical coherence tomographic angiography, renal function, retina

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

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Most cited references 46

A review of optical coherence tomography angiography (OCTA)

Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3.

Optical Coherence Tomography Angiography Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes

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