The relationship between the indicators of the retina condition and other target organ changes in uncomplicated essential hypertension

Background. Changes in retinal microcirculation are considered a subtle indicator of the other target organ damage in hypertension and might have prognostic value.

Objective. To establish the relationship between diameters of retinal arterioles and venules, foveal avascular zone (FAZ) area, subfoveal choroid thickness with parameters of left heart and kidneys in middle-aged patients with essential hypertension (EH) stage I-II.

Design and methods. A total of 115 people (86 males, 29 females) aged 45-59 years were examined and divided into 2 groups. The main group consisted of 70 patients with EH stage I or II. The control group comprised 45 normotensive practically healthy individuals. Patients with diabetes mellitus, impaired liver function, clinically significant ophthalmic pathology were not included. The following data were analyzed: anamnesis including smoking status; routine blood hemodynamic and biochemical parameters, serum procollagen III N-terminal propeptide (PIIINP); albumin-creatinine ratio in a single morning portion of urine, diurnal albuminuria; parameters of 24-h ambulatory blood pressure monitoring; quantitative electrocardiography (ECG) markers of left ventricular hypertrophy; transthoracic echocardiography; fundus state. Based on the scanning laser ophthalmoscopy, the central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using the method of optical coherence tomography angiography, we determined the FAZ area and subfoveal choroid thickness. Statistical data were processed using the StatSoft Statistica 10.

Results. Compared with normotensive individuals, patients with hypertension were characterized by lower values of CRAE (p = 0,009), larger FAZ area  (p = 0,019), and comparable values of CRVE, AVR, subfoveal choroid thickness (p > 0,05 for each indicator). Correlation analysis showed that in hypertensive AVR correlated with low-density lipoprotein cholesterol level (r = -0,3; p < 0,05); FAZ area with female gender (r = 0,42; p < 0,05); FAZ area with PIIINP level (r = 0,3; p < 0,05); FAZ area with diurnal albuminuria (r = 0,37; p < 0,05); CRVE with R wave amplitude in aVL lead of ECG (r = 0,31; p < 0,05); CRAE with left atrial volume index (r = -0,3; p < 0,05); subfoveal choroid thickness with age (r= -0,3; p = 0,01).

Conclusions. Middle-aged patients with uncomplicated EH are characterized by the lower CRVE values and larger FAZ area compared to normotensive individuals. In EH stage I-II, retinal microcirculation parameters are associated with indicators reflecting the other target organ damage, in particular, the left atrial volume index, R wave amplitude in aVL lead of the standard ECG, diurnal albuminuria, and serum PIIINP concentration.

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