Shah Janika, Kakihara Shinji, Busza Anna, Fawzi Amani A
Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Transl Vis Sci Technol. 2025 Jul 1;14(7):2. doi: 10.1167/tvst.14.7.2.
To assess the impact of hypertension (HTN) on microvasculature and vision in clinically referable diabetic retinopathy (DR) eyes using optical coherence tomography angiography.
We conducted a cross-sectional study of 185 eyes (139 patients) with referable DR (moderate/severe nonproliferative to naïve/quiescent proliferative DR), categorizing patients based on presence/absence of HTN. Optical coherence tomography angiography 3 × 3 mm scans were utilized to quantify geometric perfusion deficits (GPD), vessel length density, and vessel density within the superficial capillary plexus and deep capillary plexus (DCP). Linear regression analysis investigated the association between risk factors and GPD.
Our DR cohort comprised 52 nonhypertensive and 133 hypertensive eyes. After adjusting for age and dyslipidemia, we found significant differences in DCP metrics (GPD and vessel length density) between groups. The mean DCP GPD was higher in DR eyes with HTN compared with those without (7.06 ± 4.33 vs. 5.58 ± 2.85%; P = 0.032). Conversely, DCP vessel length density was lower in hypertensive DR eyes compared to nonhypertensive DR eyes (0.17 ± 0.02 mm-1 vs. 0.18 ± 0.02 mm-1; P = 0.031). Multivariable analysis confirmed a significant independent association between HTN (β = 0.250; P = 0.036) and DCP GPD. Worse vision was moderately associated with worsening DCP GPD (P < 0.001) in hypertensive DR eyes.
In referable DR eyes, HTN is associated with worse DCP nonperfusion and compromised vision. Therefore, heightened surveillance, in addition to blood pressure control, may need to be prioritized for this high-risk population with comorbid diabetes and HTN.
HTN is associated with worse vision and ischemia in the deep capillary layer of referable DR eyes, emphasizing the importance of monitoring patients with both comorbidities.
使用光学相干断层扫描血管造影术评估高血压（HTN）对临床可诊断的糖尿病视网膜病变（DR）眼睛的微血管和视力的影响。
我们对185只眼睛（139例患者）进行了一项横断面研究，这些眼睛患有可诊断的DR（中度/重度非增殖性至初发/静止增殖性DR），根据是否存在HTN对患者进行分类。使用光学相干断层扫描血管造影术3×3毫米扫描来量化几何灌注缺陷（GPD）、血管长度密度以及浅表毛细血管丛和深层毛细血管丛（DCP）内的血管密度。线性回归分析研究了危险因素与GPD之间的关联。
我们的DR队列包括52只非高血压眼睛和133只高血压眼睛。在调整年龄和血脂异常后，我们发现两组之间DCP指标（GPD和血管长度密度）存在显著差异。与无HTN的DR眼睛相比，有HTN的DR眼睛的平均DCP GPD更高（7.06±4.33%对5.58±2.85%；P = 0.032）。相反，高血压DR眼睛的DCP血管长度密度低于非高血压DR眼睛（0.17±0.02毫米-1对0.18±0.02毫米-1；P = 0.031）。多变量分析证实HTN（β = 0.250；P = 0.036）与DCP GPD之间存在显著的独立关联。在高血压DR眼睛中，视力越差与DCP GPD恶化中度相关（P < 0.001）。
在可诊断的DR眼睛中，HTN与更严重的DCP无灌注和视力受损有关。因此，对于患有糖尿病和HTN合并症的高危人群，除了控制血压外，可能需要优先加强监测。
HTN与可诊断的DR眼睛深层毛细血管层中更差的视力和缺血有关，强调了对两种合并症患者进行监测的重要性。
