Impact of Arterial Hypertension on the Eye: A Review of the Pathogenesis, Diagnostic Methods, and Treatment of Hypertensive Retinopathy

Abstract

The number of patients with arterial hypertension is continually increasing. Hypertension can cause organ complications, called hypertension-mediated organ damage (HMOD). One example is hypertensive retinopathy, in which high blood pressure (BP) damages both the retinal microcirculation and the retinal nerve fiber layer (RNFL). This can result in progressive and painless vision deterioration in some groups of patients. Unlike anywhere else in the human body, the microvasculature of the retina can be observed in vivo, and the progression of changes can be closely monitored. The harmful effect of increased BP on the eye is not only limited to hypertensive retinopathy, but can also lead to an exacerbation of diabetic retinopathy (DR) and to an increase in intraocular pressure (IOP), and it can also trigger the formation of thromboembolic lesions. This review presents an update on the pathogenesis of hypertensive retinopathy and the use of adaptive optics (AO) combined with optical coherence tomography (OCT) to evaluate the retinal microvasculature. The latest progress and directions of research in the field of hypertensive retinopathy are also discussed.

Figure 1

Patient with hypertensive retinopathy. Silver wiring sign (black arrows). Figure was prepared in Microsoft PowerPoint 2019 (Microsoft Corporation).

Figure 2

Factors involved in the pathogenesis of hypertensive retinopathy. RAAS – renin-angiotensin-aldosterone system. Figure was prepared in Microsoft PowerPoint 2019 (Microsoft Corporation).

Figure 3

Wall-to-lumen ratio of patient without hypertension (0.240). (A) Image from rtx1 Adaptive Optics Retinal Camera. (B) Area in the red square enlarged. Figure was prepared in Microsoft PowerPoint 2019 (Microsoft Corporation).

Figure 4

Increased wall-to-lumen ratio of patient with hypertension (0.370). (A) Image from rtx1 Adaptive Optics Retinal Camera. (B) Area in the red square enlarged. Figure was prepared in Microsoft PowerPoint 2019 (Microsoft Corporation).