Choriocapillaris microvasculature dysfunction in systemic hypertension

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.

The Application of Optical Coherence Tomography Angiography in Systemic Hypertension: A Meta-Analysis

“…In this meta-analysis, the data (6,7,(19)(20)(21)(22)(23)(24)(25)(26)(27) shows that systemic hypertension is associated with reduction of vascular density in the superficial capillary plexus (SVD and FAZ area) and deep capillary plexus (DVD) at the macula (Figure 2). This outcome suggests the potential of OCTA technology to serve as tool for pre-clinical retinal microvascular changes in systemic hypertension, where changes in the small retinal vessels may potentially be imaging biomarkers to risk stratify hypertensive complications in end-organs such as the brain, heart, and kidney (28).…”

“…For the optic nerve head, five studies analyzed peripapillary vessel density ( 6 , 20 , 23 – 25 ), two analyzed inside disc perfusion density ( 20 , 25 ), one analyzed vessel caliber ( 19 ), and one analyzed vessel density (length) ( 23 ). For the choriocapillaris, two studies analyzed density of flow deficits ( 21 , 22 ), two analyzed size of flow deficits ( 21 , 22 ), and two analyzed number of flow deficits ( 21 , 22 ). Nine studies used spectral domain OCTA (SD-OCTA) devices, while two used swept source OCTA (SS-OCTA).…”

“…For the optic nerve head, five studies analyzed peripapillary vessel density (6,20,(23)(24)(25), two analyzed inside disc perfusion density (20,25), one analyzed vessel caliber (19), and one analyzed vessel density (length) (23). For the choriocapillaris, two studies analyzed density of flow deficits (21,22), two analyzed size of flow deficits (21,22), and two analyzed number of flow Age is shown as mean +/-SD in years, sex is shown as number of males, smoking is shown as number of smokers, BMI is shown as mean +/-SD in kg/m2, dyslipidemia is shown as number of participants with dyslipidemia, diabetes is shown as number of participants with diabetes, systolic and diastolic BP is shown as mean +/-SD in mmHg.…”

“…Frontiers in Medicine | www.frontiersin.org deficits (21,22). Nine studies used spectral domain OCTA (SD-OCTA) devices, while two used swept source OCTA (SS-OCTA).…”

Retinal oxygen delivery and extraction in ophthalmologically healthy subjects with different blood pressure status

“…57,58 This could also apply to AHT, since it has been shown that AHT, especially when poorly controlled, has a detrimental effect on the choriocapillaris. 59 The magnitude of this effect is unknown, but it should be able to counteract opposing forces that would tend to reduce VO2, at least theoretically, such as reduced mean circulation time, shunting of flow, and deep capillary rarefaction. 60,61 Secondly, experimental evidence and mathematical models support that, in the presence of increased O2 availability, the O2 consumption of the inner retina (especially that of the inner and outer plexiform layers) increases, a mechanism that helps to keep inner retinal O2 levels relatively stable.…”