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Hypertensive eye disease

Nature Reviews Disease Primers volume 8, Article number: 14 (2022) Cite this article

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Abstract

Hypertensive eye disease includes a spectrum of pathological changes, the most well known being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (for example, kidney disease) elsewhere in the body. Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification.

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Fig. 1: Manifestations of hypertensive eye disease.
Fig. 2: The effect of elevated BP on the eye.
Fig. 3: Examples of hypertensive retinopathy.
Fig. 4: An example of hypertensive choroidopathy.
Fig. 5: Retinal and choroidal capillary networks in patients with hypertension.
Fig. 6: Measurement of choriocapillaris flow deficits from optical coherence tomography angiography images.
Fig. 7: Management flow chart.

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Acknowledgements

The authors thank the team from CUHK Ophthalmic Reading Centre, Hong Kong, the team from SNEC Ocular Reading Centre, Singapore, J. Chua from Singapore Eye Research Institute, Singapore, and H. Khalid from Moorfields Eye Hospital, UK, for their help in preparing the figures in this paper. V.B. is supported in part by a departmental grant NIH/NEI core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine), and by NIH/NINDS (RO1NSO89694). P.A.K. is supported by a Moorfields Eye Charity Career Development Award (R190028A) and a UK Research & Innovation Future Leaders Fellowship (MR/T019050/1). E.L.S is supported by Canadian Institutes of Health Research (CIHR) First Pilot Foundation grant 14334 and a Distinguished James McGill Professor Award from McGill University.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China

    Carol Y. Cheung

  2. Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA, USA

    Valérie Biousse

  3. NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK

    Pearse A. Keane

  4. Institute of Ophthalmology, University College London, London, UK

    Pearse A. Keane

  5. Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada

    Ernesto L. Schiffrin

  6. Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore

    Tien Y. Wong

  7. Tsinghua Medicine, Tsinghua University, Beijing, China

    Tien Y. Wong

Authors
  1. Carol Y. Cheung
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  2. Valérie Biousse
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  3. Pearse A. Keane
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  4. Ernesto L. Schiffrin
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  5. Tien Y. Wong
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Contributions

Introduction (C.Y.C., E.L.S., P.A.K. and T.Y.W.); Epidemiology (C.Y.C. and T.Y.W.); Mechanisms/pathophysiology (C.Y.C., V.B., E.L.S. and T.Y.W.); Diagnosis, screening and prevention (C.Y.C., V.B., P.A.K. and T.Y.W.); Management (C.Y.C., E.L.S. and T.Y.W.); Quality of life (C.Y.C.); Outlook (C.Y.C., V.B., P.A.K., E.L.S. and T.Y.W.); Overview of Primer (T.Y.W.).

Corresponding author

Correspondence to Tien Y. Wong.

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Competing interests

P.A.K. has acted as a consultant for Apellis, Bitfount, DeepMind, Roche and Novartis and is an equity owner in Big Picture Medical. P.A.K has received speaker fees from Allergen, Bayer, Heidelberg Engineering and Topcon. T.Y.W. is a consultant for Allergan, Bayer, Boehringer-Ingelheim, Eden Ophthalmic, Genentech, Iveric Bio, Merck, Novartis, Oxurion (ThromboGenics), Roche, Samsung, Shanghai Henlius and Zhaoke Pharmaceutical. T.Y.W. is an inventor, holds patents and is a co-founder of start-up companies (plano and EyRiS), which have interests in and develop digital solutions for eye diseases. C.Y.C., V.B. and E.L.S. declare no competing interests.

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Nature Reviews Disease Primers thanks M. Larson, who co-reviewed with M. E. W. Torm; T. Peto; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Cheung, C.Y., Biousse, V., Keane, P.A. et al. Hypertensive eye disease. Nat Rev Dis Primers 8, 14 (2022). https://doi.org/10.1038/s41572-022-00342-0

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