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Invest Ophthalmol Vis Sci. 2020 Jul 1;61(8):42. doi: 10.1167/iovs.61.8.42.
To investigate retinal neurovascular structural changes in patients with essential hypertension.
This observational cross-sectional study consisted of 199 right eyes from 169 nondiabetic essential hypertensive patients, divided into groups as follows: group A, 113 patients with hypertensive retinopathy (HTNR); group B, 56 patients without HTNR; and a control group of 30 healthy subjects. Peripapillary retinal nerve fiber layer (RNFL), radial peripapillary segmented (RPC), ganglion cell-inner plexiform layer (GC-IPL), and superficial (SVP) and deep (DVP) vascular plexus density at the macula (6 × 6 mm2) were measured by optical coherence tomography angiography (OCTA).
DVP density was significantly reduced in groups A and B compared to the control group (group A DVP, P = 0.001; group B DVP P = 0.002). GC-IPL, RNFL thickness, and RPC and SVP density in group A were significantly decreased compared to the control group or group B (all P < 0.05). In hypertensive patients, GC-IPL and RNFL thickness were negatively correlated with severity of HTNR (GC-IPL, r = -0.331, P < 0.001; RNFL, r = -0.583, P < 0.001) and level of home blood pressure monitoring (HBPM) (GC-IPL, r = -0.160, P = 0.050; RNFL, r = -0.282, P = 0.001) and were positively correlated with SVP (GC-IPL, r = 0.267, P = 0.002; RNFL, r = 0.361, P < 0.001) and RPC density (GC-IPL, r = 0.298, P < 0.001; RNFL, r = 0.663, P < 0.001). Among subjects with grade 2 or 3 retinopathy, the superior RNFL was significantly thinner in patients with high HBPM level than in those with normal HBPM level (grade 2, P = 0.016; grade 3, P = 0.006).
Reduction of retinal vessel density and RNFL thickness is observed in patients with HTNR and is inversely associated with level of HBPM.
研究原发性高血压患者视网膜神经血管结构的变化。
本研究为观察性横断面研究，纳入 169 例非糖尿病原发性高血压患者的 199 只右眼，分为以下三组：A 组 113 例患者合并高血压性视网膜病变（HTNR），B 组 56 例患者无 HTNR，对照组为 30 例健康受试者。采用光学相干断层血管造影术（OCTA）测量视盘旁视网膜神经纤维层（RNFL）、放射状视盘节段（RPC）、神经节细胞-内丛状层（GC-IPL）以及黄斑区（6×6mm²）浅层（SVP）和深层（DVP）血管丛的密度。
与对照组相比，A 组和 B 组的 DVP 密度均显著降低（A 组 DVP，P=0.001；B 组 DVP，P=0.002）。与对照组或 B 组相比，A 组的 GC-IPL、RNFL 厚度以及 RPC 和 SVP 密度均显著降低（均 P<0.05）。在高血压患者中，GC-IPL 和 RNFL 厚度与 HTNR 的严重程度（GC-IPL，r=-0.331，P<0.001；RNFL，r=-0.583，P<0.001）和家庭血压监测（HBPM）水平（GC-IPL，r=-0.160，P=0.050；RNFL，r=-0.282，P=0.001）呈负相关，与 SVP 呈正相关（GC-IPL，r=0.267，P=0.002；RNFL，r=0.361，P<0.001）和 RPC 密度（GC-IPL，r=0.298，P<0.001；RNFL，r=0.663，P<0.001）呈正相关。在视网膜病变程度为 2 级或 3 级的患者中，HBPM 水平较高的患者其上方 RNFL 明显变薄（2 级，P=0.016；3 级，P=0.006）。
原发性高血压合并 HTNR 患者的视网膜血管密度和 RNFL 厚度降低，且与 HBPM 水平呈负相关。
