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Association of hypertension defined by the 2017 ACC/AHA guideline and choroidal thickness changes in type 2 diabetes: a 2-year longitudinal study

Eye volume 39, pages 162–169 (2025)Cite this article

Subjects

Abstract

Purpose

This prospective cohort study investigated the longitudinal relationship between hypertension (HTN), defined by the 2017 ACC/AHA guidelines, and changes in choroidal thickness (CT) in patients with type 2 diabetes.

Methods

Patients aged 30–80 years from the Guangzhou Diabetic Eye Study were categorized into non-HTN, stage 1-HTN, and stage 2-HTN groups based on BP criteria. Macular and parapapillary CT were measured using swept-source optical coherence tomography (SS-OCT). Mixed linear regression models analysed CT decline rates over a median 2.1-year follow-up, adjusting for confounders.

Results

803 diabetes patients were included. Both stage 1-HTN and stage 2-HTN groups showed significantly thinner macular and parapapillary CT compared to non-HTN (all P < 0.05). Stage 2-HTN correlated with reduced macular CT thinning (coef = −11.29 μm/year; 95% CI, −22.36 to −0.22; P = 0.046) after adjustment, but not in the parapapillary area (coef = −4.07 μm/year; 95% CI, −12.89 to 4.74; P = 0.365). Subgroup analyses indicated faster macular CT decline in stage 2-HTN among those <65 years old (coef = −20.31 μm/year; 95% CI, −35.67 to −4.95; P = 0.10), males (coef = −14.1 μm/year; 95% CI, −32.54 to −4.33; P = 0.004), BMI ≥ 25 kg/m2 (coef = −10.24 μm/year; 95% CI, −26.86 to −6.38; P = 0.007), HbA1c > 6.5% (coef = −8.91 μm/year; 95% CI, −13.49 to −4.68; P = 0.001), and diabetes duration <10 years (coef = −12.78 μm/year; 95% CI, −27.48 to −1.91; P = 0.008).

Conclusion

Stage 2-HTN is associated with accelerated macular CT loss in diabetic patients, suggesting macular CT measurements could potentially serve as early indicators of systemic hypertension. Further research is needed to establish precise CT cutoff values for clinical use in detecting and monitoring hypertension-related ocular changes.

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Fig. 1: Overall workflow of this longitudinal study.
Fig. 2: Scatter and Box Plots of macular and parapapillary CT at each visit.

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Data availability

Correspondence and requests for materials should be addressed to Wenyong Huang.

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Acknowledgements

This study was completed using data from Guangzhou Diabetic Eye Study in Zhongshan Ophthalmic Center. Thanks very much to all participants. WH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This study was funded by the National Natural Science Foundation of China (82171084).

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Author notes

  1. These authors contributed equally: Kaiqun Liu, Yihang Fu.

Authors and Affiliations

  1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China

    Kaiqun Liu, Yihang Fu, Mengmeng Ye, Riqian Liu, Yuxiang Mao & Wenyong Huang

  2. Department of Rheumatology and Immunology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China

    Ting Li

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  1. Kaiqun Liu
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Contributions

Study concept and design: KL, YF, WH, YM; Acquisition, analyses, or interpretation: All authors; Drafting of the manuscript: KL, YF, MY; Critical revision of the manuscript for important intellectual content: All authors; Statistical analyses: KL, YF, RL; Obtained funding: WH; Administrative, technical, or material support: WH, KL, TL; Study supervision: WH, YM.

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Correspondence to Yuxiang Mao or Wenyong Huang.

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Liu, K., Fu, Y., Ye, M. et al. Association of hypertension defined by the 2017 ACC/AHA guideline and choroidal thickness changes in type 2 diabetes: a 2-year longitudinal study. Eye 39, 162–169 (2025). https://doi.org/10.1038/s41433-024-03401-w

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