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Impact of Arterial Hypertension on the Eye

  • Special Situations in the Management of Hypertension (NK Hollenberg, Section Editor)
  • Published:
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Abstract

Systemic hypertension has been linked to a wide range of major eye diseases. High arterial blood pressure (BP) decreases choroidal circulatory flow, increases intraocular pressure, and is associated with retinal microvascular abnormalities and prevalence of retinal vein occlusion (RVO) and retinopathy. This review offers a comprehensive overview of ocular diseases associated with hypertension and emphasizes their importance as predictors to future cardiovascular events. It also gives evidence-based clinical data for the therapeutic approach of eye disease in hypertensive patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med. 2004;351:2310–7.

    Article  CAS  PubMed  Google Scholar 

  2. •• Liew G, Campbell S, Klein R, et al. Ten-year longitudinal changes in retinal microvascular lesions: the atherosclerosis risk in communities study. Ophthalmology. 2011;118:1612–8. This study shows how retinal vascular changes are related to high blood pressure.

    Article  PubMed  Google Scholar 

  3. Wang JJ, Liew G, Wong TY, et al. Retinal vascular calibre and the risk of coronary heart disease-related death. Heart. 2006;92:1583–7.

    Article  CAS  PubMed  Google Scholar 

  4. Ibrahim YW, Bots ML, Mulder PG, et al. Number of perifoveal vessels in aging, hypertension and atherosclerosis: the Rotterdam Study. Invest Ophthalmol Vis Sci. 1998;39:1049–53.

    CAS  PubMed  Google Scholar 

  5. Haefliger IO, Meyer P, Flammer J, Luescher TF. The vascular endothelium as a regulator of the ocular circulation: new concept in ophthalmology? Surv Ophthalmol. 1994;39:123–32.

    Article  CAS  PubMed  Google Scholar 

  6. Hayreh SS. Role of nocturnal arterial hypotension in the development of ocular manifestations of systemic arterial hypertension. Curr Opin Ophthalmol. 1999;10:474–82.

    Article  CAS  PubMed  Google Scholar 

  7. •• Xu A, Grunwald JE, Metelitsina TI, et al. Association of risk factors for choroidal neovascularization in age-related macular degeneration with decreased foveolar choroidal circulation. Am J Ophthalmol. 2010;150:40–7. This study showed that high BP compromises choroidal circulatory flow.

    Article  PubMed  Google Scholar 

  8. • Wang S, Xu L, Jonas JB, et al. Major eye diseases and risk factors associated with systemic hypertension in an adult Chinese population: The Beijing Eye Study. Ophthalmology. 2009;116:2373–80. This study showed that high blood pressure is associated with retinal microvascular abnormalities.

    Article  PubMed  Google Scholar 

  9. Stanton AV, Wasan B, Cerutti A, et al. Vascular network changes in the retina with age and hypertension. J Hypertens. 1995;13:1724–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kutschbach P, Wolf S, Sieveking M, et al. Retinal capillary density in patients with arterial hypertension: 2-year follow-up. Graefes Arch Clin Exp Ophthalmol. 1998;236:410–4.

    Article  CAS  PubMed  Google Scholar 

  11. Vaajanen A, Luhtala S, Oksala O, Vapaatalo H. Does the renin-angiotensin system also regulate intra-ocular pressure? Ann Med. 2008;40(6):418–27.

    Article  CAS  PubMed  Google Scholar 

  12. Wilkinson-Berka JL. Angiotensin and diabetic retinopathy. Int J Biochem Cell Biol. 2006;38:752–65.

    Article  CAS  PubMed  Google Scholar 

  13. Wong TY, McIntosh I. Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality. Br Med Bull. 2005;7(73–74):57–70.

    Article  Google Scholar 

  14. Klein R, Klein BE, Moss SE, et al. The relationship of retinopathy in persons without diabetes to the 15-year incidence of diabetes and hypertension: Beaver Dam Eye Study. Trans Am Opthamol Soc. 2006;104:98–107.

    Google Scholar 

  15. Klein R, Klein BE, Moss SE, Wang Q. Hypertension and retinopathy, arteriolar narrowing, and arteriovenous nicking in a population. Arch Ophthalmol. 1994;112:92–8.

    Article  CAS  PubMed  Google Scholar 

  16. Klein R, Klein BE, Moss SE. The relation of systemic hypertension to changes in the retinal vasculature. The Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 1997;95:329–50.

    CAS  PubMed  Google Scholar 

  17. Sharret AR, Hubbard LD, Cooper LS, et al. Retinal arteriolar diameters and elevated blood pressure. The Atherosclerosis Risk in Communities Study. Am J Epidemiol. 1999;150:263–70.

    Article  Google Scholar 

  18. Wong TY, Hubbard LD, Klein R, et al. Retinal microvascular abnormalities and blood pressure in older people: the cardiovascular health study. Br J Ophthalmol. 2002;86:1007–13.

    Article  CAS  PubMed  Google Scholar 

  19. Wong TY, Klein R, Klein BEK, Meuer SM, Hubbard LD. Retinal vessel diameters and their associations with age and blood pressure. Invest Ophthalmol Vis Sci. 2003;44:4644–50.

    Article  PubMed  Google Scholar 

  20. Wong TY, Klein R, Nieto FJ, et al. Retinal microvascular abnormalities and ten-year cardiovascular mortality. A population-based case-control study. Ophthalmology. 2003;110:933–40.

    Article  PubMed  Google Scholar 

  21. Wong TY, Klein R, Couper DJ, et al. Retinal microvascular abnormalities and incident clinical strokes. The atherosclerosis risk in the communities study. Lancet. 2001;358:1134–40.

    Article  CAS  PubMed  Google Scholar 

  22. Wong TY, Rosamond W, Chang PP, et al. Retinopathy and risk of congestive heart failure. JAMA. 2005;293:63–9.

    Article  CAS  PubMed  Google Scholar 

  23. Patton N, Aslam T, Macgillivray T, et al. Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J Anat. 2005;206:319–48.

    Article  PubMed  Google Scholar 

  24. Delles C, Michelson G, Harazny J, et al. Impaired endothelial function of the retinal vasculature in hypertensive patients. Stroke. 2004;35:1289–93.

    Article  CAS  PubMed  Google Scholar 

  25. Klein R, Sharrett AR, Klein BEK, et al. Are retinal arteriolar abnormalities related to atherosclerosis? The atherosclerosis risk in communities study. Arterioscler Thromb Vasc Biol. 2000;20:1644–50.

    Article  CAS  PubMed  Google Scholar 

  26. Katsi V, Vlachopoulos C, Souretis G et al. Association between retinal microcirculation and aortic stiffness in hypertensive patients. Int J Cardiol. 2011 (Epub ahead of print).

  27. Nguyen TT, Islam FM, Farouque HM, et al. Retinal vascular caliber and brachial flow mediated dilation: the Multi-Ethnic Study of Atherosclerosis. Stroke. 2010;41:1343–8.

    Article  PubMed  Google Scholar 

  28. Cuspidi C, Sala C. Retinal wall-to-lumen ratio: a new marker of endothelial function? J Hypertens. 2011;28:123–9.

    Google Scholar 

  29. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1974;268:336–45.

    Article  CAS  PubMed  Google Scholar 

  30. Ikram MK, de Jong FJ, Vingerling JR, et al. Are retinal arteriolar or venular diameters associated with markers for cardiovascular disorders? The Rotterdam study. Invest Ophthalmol Vis Sci. 2004;45:2129–34.

    Article  PubMed  Google Scholar 

  31. Wong TY, Klein R, Sharrett AR, et al. The prevalence and risk factors of retinal microvascular abnormalities in older people: the Cardiovascular Health Study. Ophthalmology. 2003;110:658–66.

    Article  PubMed  Google Scholar 

  32. Wong TY, McIntosh R. Systemic associations of retinal microvascular signs: a review of recent population-based studies. Ophthal Physiol Opt. 2005;25:195–204.

    Article  Google Scholar 

  33. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28(12):1462–536.

  34. Ahmed ME, Walker JM, Beevers DG, Beevers M. Lack of difference between malignant and accelerated hypertension. BMJ (Clin Res Ed). 1986;25(6515):235–7.

    Article  Google Scholar 

  35. Pontremoli R, Sofia A, Tirotta A, et al. The deletion polymorphism of the angiotensin l-converting enzyme gene is associated with target organ damage in essential hypertension. J Am Soc Nephrol. 1996;7:2550–8.

    CAS  PubMed  Google Scholar 

  36. Pontremoli R, Sofia A, Ravera M, et al. Prevalence and clinical correlates of microalbuminuria in essential hypertension. The MAGIC Study. Hypertension. 1997;30:1135–43.

    Article  CAS  PubMed  Google Scholar 

  37. •• Tanabe Y, Kawasaki R, Wang JJ, et al. Retinal arteriolar narrowing predicts 5-year risk of hypertension in Japanese people: the Funagata study. Microcirculation. 2010;17:94–102. This study showed that retinal arteriolar narrowing may precede the presentation of hypertension by years in initially normotensive individuals.

    Article  PubMed  Google Scholar 

  38. Wong TY, Klein R, Sharrett AR, et al. Retinal arteriolar diameters and risk of hypertension. Ann Intern Med. 2004;140:248–55.

    PubMed  Google Scholar 

  39. Dahlof B, Stenkula S, Hansson L. Hypertensive retinal vascular changes before and after treatment. Blood Press. 1992;1:35–44.

    Article  CAS  PubMed  Google Scholar 

  40. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998 Sep 12;317(7160):703–13.

  41. Bock KD. Regression of retinal vascular changes by antihypertensive therapy. Hypertension. 1984;6(6 pt 2):III1158–62.

    Google Scholar 

  42. Chaturvedi N, Sjolie AK, Stephenson JM, et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EURODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes Mellitus. Lancet. 1998;351(9095):28–31.

    Article  CAS  PubMed  Google Scholar 

  43. Ruggenenti P, Iliev I, Filipponi M, et al. Effect of trandolapril on regression of retinopathy in hypertensive patients with type 2 diabetes: a prespecified analysis of the benedict trial. J Ophthalmol. 2010;2010:106384. Epub 2010 Jun 10.

  44. Sjølie AK, Klein R, Porta M, Orchard T, et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet. 2008;372(9647):1385–93.

    Article  PubMed  Google Scholar 

  45. Wolffsohn JS, Hurcomb PG. Hypertension and the eye. Curr Hypertens Rep. 2002;4:471–6.

    Article  PubMed  Google Scholar 

  46. Luft FC, Mervaala E, Muller DN, et al. Hypertension-induced end-organ damage: a new transgenic approach to an old problem. Hypertension. 1999;33:212–8.

    Article  CAS  PubMed  Google Scholar 

  47. Xu A, Grunwald JE, Metelitsina TI, et al. Association of risk factors for choroidal neovascularization in age-related macular degeneration with decreased foveolar choroidal circulation. Am J Ophthalmol. 2010;150:40–7.

    Article  PubMed  Google Scholar 

  48. The Central Vein Occlusion Study Group. Natural history and clinical management of central retinal vein occlusion. Arch Ophthalmol. 1997;15:486–91.

    Article  Google Scholar 

  49. Arakawa S, Yasuda M, Nagata M, et al. Nine-year incidence and risk factors for retinal vein occlusion in a general Japanese population: the Hisayama Study. Invest Ophthalmol Vis Sci. 2011;52(8):5905–9.

    Article  PubMed  Google Scholar 

  50. Sodi A, Giambene B, Marcucci R, et al. Atherosclerotic and thrombophilic risk factors in patients with ischemic central retinal vein occlusion. Retina. 2011;31(4):724–9.

    CAS  PubMed  Google Scholar 

  51. O’Mahoney, Wang DT, et al. Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol. 2008;126:692–9.

    Article  PubMed  Google Scholar 

  52. • Wong TY, Scott IU. Clinical practice: retinal vein occlusion. N Engl J Med. 2011;364:979. This article associates retinal vein emboli with vascular risk factors. However, it fails to reveal a relation with risk for death from cardiovascular disease.

    Article  CAS  Google Scholar 

  53. O’Donnell BA, Mitchell P. The clinical features and associations of retinal emboli. Aust N Z J Ophthalmol. 1992;20:11–7.

    Article  PubMed  Google Scholar 

  54. Mohamed Q, McIntosh RL, Saw SM, Wong TY. Interventions for central retinal vein occlusion: an evidence-based systematic review. Ophthalmology. 2007;114:507–19.

    Article  PubMed  Google Scholar 

  55. Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1432–44.

    Article  CAS  PubMed  Google Scholar 

  56. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular agerelated macular degeneration. N Engl J Med. 2006;355:1419–31.

    Article  CAS  PubMed  Google Scholar 

  57. Klein R, Klein BE, Jensen SC, Moss SE, Meuer SM. Retinal emboli and stroke: the beaver dam eye study. Arch Ophthalmol. 1999;117:1063–8.

    Article  CAS  PubMed  Google Scholar 

  58. Mitchell P, Wang JJ, Li W, Leeder SR, Smith W. Prevalence of asymptomatic retinal emboli in an australian urban community. Stroke. 1997;28:63–6.

    Article  CAS  PubMed  Google Scholar 

  59. Wong TY, Klein R. Retinal arteriolar emboli: epidemiology and risk of stroke. Curr Opin Ophthalmol. 2002;13:142–6.

    Article  PubMed  Google Scholar 

  60. Wang JJ, Cugati S, Knudtson MD, et al. Retinal arteriolar emboli and long-term mortality: pooled data analysis from two older populations. Stroke. 2006;37:1833–6.

    Article  PubMed  Google Scholar 

  61. Wong TY, Larsen EK, Klein R, Mitchell P, Couper DJ, Klein BE, et al. Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the atherosclerosis risk in communities & cardiovascular health studies. Ophthalmology. 2005;112:540–7.

    Article  PubMed  Google Scholar 

  62. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1939;197:332–43.

    Article  Google Scholar 

  63. Rabb MF, Gagliano DA, Teske MP. Retinal arterial macroaneurysms. Surv Ophthalmol. 1988;33:73–96.

    Article  CAS  PubMed  Google Scholar 

  64. Drance SM. Some factors in the production of low tension glaucoma. Br J Ophthalmol. 1972;56:229–42.

    Article  CAS  PubMed  Google Scholar 

  65. Leske MC. Ocular perfusion pressure and glaucoma: clinical trial and epidemiologic findings. Curr Opin Ophthalmol. 2009;20:73–8.

    Article  PubMed  Google Scholar 

  66. Leske MC, Connell AM, Wu SY, et al. Risk factors for open-angle glaucoma. The Barbados eye study. Arch Ophthalmol. 1995;113(7):918–24.

    Article  CAS  PubMed  Google Scholar 

  67. Mitchell P, Lee AJ, Rochtchina E, et al. Open-angle glaucoma and systemic hypertension: the blue mountains eye study. J Glaucoma. 2004;13(4):319–26.

    Article  PubMed  Google Scholar 

  68. • Memarzadeh F, Ying-Lai M, Chung J, et al. Blood pressure, perfusion pressure, and open-angle glaucoma: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci. 2010;51(6):2872–7. This study showed that that low diastolic perfusion pressure is associated with a higher prevalence of glaucoma.

    Article  PubMed  Google Scholar 

  69. Bonomi L, Marchini G, Marraffa M, et al. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000;107(7):1287–93.

    Article  CAS  PubMed  Google Scholar 

  70. Tielsch JM, Katz J, Sommer A, Quigley HA, Javitt JC. Hypertension, perfusion pressure, and open-angle glaucoma: a population based assessment. Arch Ophthalmol. 1995;113:216–21.

    Article  CAS  PubMed  Google Scholar 

  71. Hayreh SS, Zimmerman MB, Podhajski P, Alward WLM. Nocturnal arterial hypotension and its role in optic nerve and ocular ischemic disorders. Am J Ophthalmol. 1994;117:603–24.

    CAS  PubMed  Google Scholar 

  72. Graham SL, Drance SM. Nocturnal hypotension: role in glaucoma progression. Surv Opthalmol. 1999;43(Suppl):10–6.

    Article  Google Scholar 

  73. Werne A, Harris A, Moore D, BenZion I, Siesky B. The circadian variations in systemic blood pressure, ocular perfusion pressure, and ocular blood flow: risk factors for glaucoma? Surv Ophthalmol. 2008;53:559–67.

    Article  PubMed  Google Scholar 

  74. Grunwald JE, Piltz J, Hariprasad SM. Optic nerve blood flow in glaucoma: effect of systemic hypertension. Am J Ophthalmol. 1999;127:516–22.

    Article  CAS  PubMed  Google Scholar 

  75. Friedman DS, Congdon NG, Kempen J, Tielsch JM, O’Colmain B. Vision Problems in the U. S.: prevalence of adult vision impairment and age-related eye disease. Schaumburg: Prevent Blindness America; 2002.

    Google Scholar 

  76. Sperduto RD, Hiller R. Systemic hypertension and age–related maculopathy in the Framingham Study. Arch Ophthalmol. 1986;104(2):216–9.

    Article  CAS  PubMed  Google Scholar 

  77. Leeuwen R, Ikram MK, Vingerling JR, et al. Blood pressure, atherosclerosis, and the incidence of age-related maculopathy: the Rotterdam Study. Invest Ophthalmol Vis Sci. 2003;44:3771–7.

    Article  PubMed  Google Scholar 

  78. • Butt AL, Lee ET, Klein R, et al. Prevalence and risks factors of age-related macular degeneration in Oklahoma Indians. The Vision Keepers Study. Opthamology. 2011;118(7):1380–5. This study showed that high systolic BP and high pulse pressure are associated with an increased risk of AMD.

    Google Scholar 

  79. Macular Photocoagulation Study Group. Laser photocoagulation for juxtafoveal choroidal neovascularization. Five-year results from randomized clinical trials. Arch Ophthalmol. 1994;112:500–9.

    Article  Google Scholar 

  80. Visontai Z, Horvath T, Kollai M, Hollo G. Decreased cardiovagal regulation in exfoliation syndrome. J Glaucoma. 2008;17:133–8.

    Article  PubMed  Google Scholar 

  81. Miyazaki M, Kubota T, Kubo M, et al. The prevalence of pseudoexfoliation syndrome in a Japanese population: the Hisayama Study. J Glaucoma. 2005;14:482–4.

    Article  PubMed  Google Scholar 

  82. Brajkovic J, Kalauz-Surac I, Ergegovic A, et al. Ocular pseudoexfoliation syndrome and internal systemic diseases. Acta Clin Croat. 2007;46 Suppl 1:57–61.

    Google Scholar 

  83. Jonas JB, Grundler AE. Prevalence of diabetes mellitus and arterial hypertension in primary and secondary open-angle glaucomas. Graefes Arch Clin Exp Ophthalmol. 1998;236:202–6.

    Article  CAS  PubMed  Google Scholar 

  84. Tarkkanen A, Reunanen A, Kivela T. Frequency of systemic vascular diseases in patients with primary open-angle glaucoma and exfoliation glaucoma. Acta Ophthalmol. 2008;86:598–602.

    Article  PubMed  Google Scholar 

  85. McGill JB. Improving microvascular outcomes in patients with diabetes through management of hypertension. Postgrad Med. 2009;121(2):89–101.

    Article  PubMed  Google Scholar 

  86. Zeraatian S, Zakeri H, Boroojeny SB, et al. Effect of oral clonidine on acute intraocular pressure rise after phacoemulsification: a prospective double-blind, randomized, clinical trial. J Ocul Pharmacol Ther. 2011;27(3):293–7.

    Article  CAS  PubMed  Google Scholar 

  87. Graw J, Welzl G, Ahmad N, et al. The KORA Eye Study: a population-based study on eye diseases in Southern Germany (KORA F4). Invest Ophthalmol Vis Sci. 2011;52(10):7778–86.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiology Department, Hippokration Hospital, 10 Lefkados Street, 14526, Athens, Greece

    Vasiliki Katsi, Charalambos Vlachopoulos, Dimitris Tousoulis, George Souretis, Nikolaos Papageorgiou, Christodoulos Stefanadis & Ioannis Kallikazaros

  2. Cardiology Department, Heraklion University Hospital, Crete, Greece

    Maria Marketou & Panos Vardas

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  1. Vasiliki Katsi
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  2. Maria Marketou
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Katsi, V., Marketou, M., Vlachopoulos, C. et al. Impact of Arterial Hypertension on the Eye. Curr Hypertens Rep 14, 581–590 (2012). https://doi.org/10.1007/s11906-012-0283-6

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