Objective:

To assess retinal and choroidal microvascular features in children with stage 1 primary hypertension using OCT and OCT angiography (OCTA).

Approach:

• Study design and participants: Prospective cross-sectional study of 94 children aged 6–18 years with stage 1 primary hypertension and 60 age- and sex-comparable healthy controls. Hypertensive participants had been followed for at least one year and were not receiving antihypertensive treatm…
• Ocular assessment: Researchers used OCT and OCTA to measure retinal and choroidal parameters, including non-perfused choriocapillaris area (NPCA) in three regions centered on the fovea.

Key Findings:

• Participants had no clinically detectable ocular disease; visual acuity and eye examinations were normal.
• Foveal and subfoveal thickness, retinal capillary plexus vessel density, foveal avascular zone area, and optic nerve head vessel density did not differ significantly between groups.
• NPCA was higher in hypertensive children in all three regions: 12.3% versus 8.7% within 0.5 mm, 14.5% versus 10.2% at 0.5–1.5 mm, and 16.8% versus 12.1% at 1.5–3 mm; all differences were statistically significant.
• After adjustment for age, sex, and BMI, hypertension remained independently associated with higher NPCA in the 0.5–1.5 mm and 1.5–3 mm regions. BMI was not independently associated with NPCA.

Interpretation:

The authors suggest that choriocapillaris non-perfusion may precede more recognizable structural and retinal vascular changes of hypertensive eye disease. They note that OCTA-derived NPCA could be a potential noninvasive marker of early microvascular involvement, pending confirmation.

Limitations:

• Cross-sectional design and no longitudinal blood-pressure data.
• No detailed ambulatory blood-pressure parameters.
• Axial length was not measured.
• The automated NPCA algorithm has not been specifically validated in children.
• Residual metabolic confounding cannot be excluded.

Conclusion:

The authors call for larger longitudinal studies to clarify the timing of choriocapillaris changes in relation to systemic hypertension.

Sources:

• Study described in the provided context; published in BMC Ophthalmology