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Evidence of neurodegeneration in individuals with only mildly elevated blood pressure

Jung, Susannea,b; Bosch, Agnesa; Kohler, Nikolasa; Ott, Christiana,c; Kannenkeril, Dennisa; Dienemann, Thomasa; Harazny, Joanna M.a,d; Michelson, George; Schmieder, Roland E.a

doi: 10.1097/HJH.0000000000002164

Objective: Initiation of antihypertensive drug treatment in low-risk individuals with grade 1 hypertension is under debate. The aim of this study was to examine the impact of mildly elevated blood pressure (BP) on early neurodegenerative processes independent of ageing.

Methods: Sixty-two individuals were included in this study: 25 young (aged <40 years) and 37 older (aged ≥40 years) individuals at low cardiovascular risk and grade 1 hypertension at most. Macular retinal layer volumes of both eyes were determined by SD-OCT. Total retinal volume but also each inner retinal layer volume separately including retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and GCL-IPL were measured in each individual.

Results: Retinal layer volumes were lower among older individuals compared with young individuals (RNFL right eye: P = 0.037/left eye: P = 0.021; GCL and GCL-IPL: both eyes P < 0.001; IPL right eye: P = 0.005/left eye: P = 0.002; total retinal volume: both eyes P = 0.002) and there was an inverse correlation between retinal layer volumes and age. Partial correlation analysis, excluding age as a cofactor, revealed an inverse association between retinal layer volumes and DBP. In multiple regression analysis, DBP was identified as a determinant of retinal neurodegenerative processes.

Conclusion: In the current study, we observed an inverse association between retinal neurodegenerative processes and DBP, suggesting that BP-lowering therapy by early antihypertensive drug-treatment might be beneficial to avoid early neurodegeneration.

aDepartment of Nephrology and Hypertension

bDepartment of Cardiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU)

cParacelsus Medical School, Nuremberg, Germany

dDepartment of Pathophysiology, University of Warmia and Mazury, Olsztyn, Poland

eDepartment of Ophthalmology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany

Correspondence to Dr Roland E. Schmieder, Professor, Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany. Tel/fax: +49 9131 853 6245 6215; e-mail:

Abbreviations: BP, blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESC, European Society of Cardiology; ESH, European Society of Hypertension; EVA, early vascular ageing; FPG, fasting plasma glucose; GCL, ganglion cell layer; HbA1c, glycated hemoglobin; IPL, inner plexiform layer; LDL, low-density lipoprotein; OBP, office blood pressure; RNFL, retinal nerve fiber layer; SD-OCT, spectral-domain optical coherence tomography; SLD, super luminescence diode

Received 16 April, 2019

Revised 5 May, 2019

Accepted 6 May, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.