Associations between Midlife to Late-Life Blood Pressure Patterns with Retinal Microvasculature: The Eye Determinant of Cognition (EyeDOC) Study

Abstract

Purpose : Hypertension (HTN) negatively impacts retinal vascular health, the long term impact has yet to be quantitatively studied in the aging population. Using the population-based Atherosclerosis Risk In Communities (ARIC) cohort, we explore the associations between midlife and late-life blood pressure (BP) patterns with projection-resolved OCT angiography (OCTA)-assessed retinal microvascular measures.

Methods : EyeDOC participants who completed the ARIC Visits 1 (1987-9) and 4 (1996-8) during midlife, and Visit 6 (2016-7) during late-life were enrolled from Jackson, MS and Hagerstown, MD. BP was measured at all visits, and OCTA images were obtained in one eye per participant at the EyeDOC visit (15.6±4.7 months after Visit 6). Hypertensive BP was defined as systolic BP>140 mmHg or diastolic BP>90 mmHg, irrespective of medication use. Midlife HTN was defined as having hypertensive BP for either Visit 1 or 4; late-life HTN as having hypertensive BP at Visit 6. We use regression analysis to explore the associations between midlife and late-life BP patterns with macular vessel density (VD) in superficial vascular complex (SVC), intermediate capillary plexus (ICP), and deep capillary plexus (DCP), after adjusting for demographics, diabetic status, body mass index, smoking, drinking, HTN medications, and image signal strength.

Results : Mean age of the 466 participants was 78±4 years at Visit 6, and 63% were female. Macular SVC VD mean values were highest (49.2±6.3%) in participants not hypertensive (n=246) than those with late-life HTN only (n=114), midlife HTN only (n=54), or sustained midlife and late-life HTN (n=48); with statistically significant differences between groups (P<0.001). No differences were found in the ICP (P=0.696) or DCP (P=0.716) VD between groups. Compared to participants that were not hypertensive, those in the late-life HTN only group had lower SVC VD (β=-1.62, P=0.03). The association was largely explained by late-life systolic HTN (β=-1.99, P=0.006). No associations were found between BP patterns and ICP or DCP VD.

Conclusions : Systolic HTN that first emerges in late-life was associated with decreased retinal VD in this aging community-based cohort with 30 years of blood pressure history. This is suggestive of the beneficial effects of maintaining normal BP level on ocular vasculature health later in life.

This is a 2020 ARVO Annual Meeting abstract.