Subclinical retinal microvascular alterations assessed by optical coherence tomography angiography in children with systemic hypertension

PURPOSE To compare the foveal avascular zone (FAZ) macular and peripapillary vessel density between children with high blood pressure and healthy subjects. METHODS A total of 40 eyes of 20 children with hypertension and 40 eyes of 20 age- and sex-matched healthy controls were included. Capillary vessel density (CVD) in superficial (SCP) and deep (DCP) retinal capillary plexus, peripapillary region, and FAZ were analyzed by optical coherence tomography angiography. RESULTS The mean ages were 15.2 +/- 1.5 years (range, 10-18) in patients with hypertension and 14.4 +/- 2.8 years (range, 10-18) in healthy controls (P = 0.742). The mean FAZ area measured 0.25 +/- 0.10 mm 2 in children with hypertension and 0.25 +/- 0.09 mm 2 in healthy controls (P = 0.765). There was no significant difference between study groups in any measure of the macular SCP (P > 0.05 for all); however, the mean whole image, inferior hemisphere, and para- and perifoveal measurements of the macular DCP were significantly lower in children with hypertension than in controls (P < 0.05 for all). CONCLUSIONS Although there was no evidence of hypertensive retinopathy, subthreshold microvascular alterations were found in the DCP of the retinal circulation in pediatric hypertensives. These alterations should be considered as prognostic cues when defining whole systemic response to high blood pressure in childhood.