Impact of arterial hypertension on ocular vascular ischemia

At the ocular level, hypertension causes retinal, choroidal and optic nerve lesions, and can be complicated by obstructive and ischaemic phenomena. We set out to assess the impact of hypertension on the different types of ocular vascular ischemia.

Retrospective case-control study of patients seen in a vascular risk consultation. All patients underwent pulse wave velocity (PWV), ABI and carotid Doppler ultrasound.

187 patients were included, 76 retinal venous occlusions (RVO), 21 retinal arterial occlusions (RAO), 28 non-arteritic ischaemic neuropathies (NAION) and 62 hypertensive controls without ocular ischaemia (CP). Mean age was 64 (±11), 68 (±10), 61 (±10) and 56 (±11) years in RVO, RAO, NAION, and PC respectively (P = 0.92). RVOs had a higher frequency of hypertension (71.4%), dyslipidaemia (55%) and diabetes (47.6%) (P = 0.001, P = 0.001 and P = 0.028 respectively) compared to the other groups. In relation to subclinical organ damage, patients with RVO had higher PWV 10.7 m/s (p = 0.004), pulse pressure 66 mmHg (p = 0.009), and vascular age 66.4 years (p = 0.005), with no differences in IMT, presence of carotid plaques or ITB. The occurrence of ocular ischaemia correlated with age (p = 0.009), DM2 (p = 0.027), dyslipidaemia (p = 0.047) and presence of plaques (p = 0.019).

Hypertension is a constant in vascular ocular ischaemic pathology, having a greater impact due to arterial stiffness in RVO. Age, diabetes, dyslipidaemia and the presence of plaques will increase the appearance of ocular ischemia.