Age-Related Associations of Blood Pressure and Arterial Stiffness with Retinal Arterial Structure

To investigate the associations of systolic blood pressure (SBP) and arterial stiffness, measured via the cardio-ankle vascular index (CAVI), with retinal arterial structure assessed by OCT, and examine age-related differences.

A cross-sectional analysis of a community-based Japanese cohort.

A total of 6969 adults (mean age, 57.6 years; 69.6% women) who underwent OCT imaging between 2012 and 2016.

Peripapillary circular OCT B-scans were used to assess the 4 largest retinal arteries. OCT-derived parameters included outer diameter (OD), inner diameter (ID), wall thickness, and wall reflectivity. Multivariable linear regression adjusted for demographic, ocular, and systemic covariates. Interaction analyses evaluated age modification, followed by analyses stratified by age (<65 vs. ≥65 years).

OCT-based measurements of OD, ID, wall thickness, and wall reflectivity.

Higher SBP was associated with smaller OD (β = -0.136, 95% confidence interval [CI]: -0.151 to -0.120) and ID (β = -0.136, 95% CI: -0.150 to -0.121). The CAVI was positively associated with wall reflectivity (β = 0.371, 95% CI: -0.081 to 0.822). Interaction analyses indicated age-related modification (SBP × age for OD: β = 0.005; ID: β = 0.005; CAVI × age for wall reflectivity: β = 0.030). In stratified analyses, the inverse associations of SBP with OD and ID were stronger in participants aged <65 years (OD: β = -0.186; ID: β = -0.178) than in those aged ≥65 years (OD: β = -0.076; ID: β = -0.085). For CAVI, no clear association with wall reflectivity was found in participants aged <65 years (β = -0.165), whereas a positive association was observed in those aged ≥65 years (β = 0.725).

OCT-based retinal arterial measurements revealed age-dependent associations with systemic vascular factors. In younger adults, elevated SBP was linked to narrower arterial diameters, reflecting functional vasoconstriction, whereas in older adults, greater wall reflectivity was associated with arterial stiffness, suggesting structural remodeling. These findings support OCT as a noninvasive tool for assessing different stages of microvascular aging, warranting confirmation in longitudinal studies.

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