Retinal arteriolar remodeling in primary aldosteronism: a study with adaptive optics

Objective: Primary aldosteronism (PA) represents the most frequent form of secondary hypertension. In previous studies an hypertrophic remodeling, with smooth muscle cell growth and an increase in media to lumen ratio (MLR), has been shown in patients with primary aldosteronism (Rizzoni D et al. Hypertension 1996;28:785–790.). To date, Adaptive Optics (AO) is one of the most innovative and non-invasive methods for studying the wall-to-lumen ratio of retinal arterioles (WLR), which directly correlates with the MLR of subcutaneous small arteries (De Ciuceis C et al. J Hypertens. 2018;36(5):1154-1163.). Design and method: Therefore, the aim of this study was to evaluate microvascular structure of retinal arterioles by Adaptive Optics in PA patients, before and after pharmacological or surgical treatment, compared to essential hypertensive patients (EH). Eleven patients with PA before treatment have been matched with 11 patients with EH and 11 patients with treated PA in follow up. All patients underwent assessment of retinal microcirculation morphology with AO (RTX-1, Imagine Eyes; Orsay, FR) in order to calculate WLR and wall cross sectional area (WCSA). Results: A total of 33 patients was enrolled in the study. PA patients at the baseline showed a significant higher WLR compared to EH and to PA in follow-up (Figure 1; 0.31±0.03 vs 0.27±0.04 vs 0.275±0.03 respectively; p = 0.01). Otherwise, differences between WCSA turned out to be less relevant with no significant differences among the three groups (4500.85±879.9 vs 4195.96±553.3 vs 4278.52±836.6 respectively; p = ns). Conclusions: Our data confirm with a non-invasive technique the presence of a more evident retinal arterioles remodeling in PA patients compared to EH patients, as suggested by the increased WLR, and an improvement in WLR after PA surgical or pharmacological treatment. Further studies in a larger population are needed in order to confirm these data.