The Impact of Hypertension on Macular Perfusion in Patients With Referable Diabetic Retinopathy: An OCTA Analysis.

Purpose: To assess the impact of hypertension (HTN) on microvasculature and vision in clinically referable diabetic retinopathy (DR) eyes using optical coherence tomography angiography.

Methods: 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.

Results: 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.

Conclusions: 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.

Translational relevance: 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.