Objective ocular diagnostic features in patients with hypertension and hypertension combined with coronary heart disease

To investigate the differences in ocular collateral features among patients with hypertension and those with hypertension complicated by coronary heart disease based on traditional Chinese medicine (TCM) ocular diagnostic theory and scleral image analysis, and provide evidence for the application of objective TCM ocular diagnostic technology in the early screening of cardiovascular diseases.

Patients with hypertension who attended the Department of Cardiology at Dongzhimen Hospital of Beijing University of Chinese Medicine between June and December 2024 were enrolled as the hypertension group (n = 222). In contrast, patients with hypertension complicated by coronary heart disease were enrolled as the combined group (n = 176). Healthy individuals recruited during the same period served as the control group (n= 162). An ocular diagnostic instrument was used to collect scleral images of both eyes from five orientations (upward, downward, leftward, rightward, and frontal gaze). Morphological, color, and regional features of ocular collaterals were digitally extracted and analyzed.

Morphological feature analysis showed that the prevalence of "Dots" and "Vessels" was lower, whereas that of "Hills" was higher in both the hypertension and hypertension with coronary heart disease groups than in the control group (P<0.05). The prevalence of "Hills" was higher in the hypertension with coronary heart disease group than in the hypertension group and showed an increasing trend among the three groups (P<0.01). In color features, both disease groups showed lower proportions of "Dusky pink", and higher proportions of "Yellow" than control group (P < 0.05). The hypertension group showed higher proportions of "Dark reddish" and lower proportions of "Purple" (P < 0.05). The combined group showed lower proportions of "Pink" and "Light yellow" and higher proportions of "Dusky brown" (P<0.05), whereas "Light yellow" was lower than that in the hypertension group (P< 0.05). Regional feature analysis showed lower prevalence of "R7 (Lung)" "R8 (Kidney)" and "R10 (Kidney)" in both disease groups than in the control group, whereas "R6 (Lung)" was more prevalent in the hypertension group than in the hypertension with coronary heart disease and control groups (P< 0.05).

Significant differences were observed in the morphological, color, and regional distribution characteristics of ocular collaterals among the hypertension, the combined and control groups. Ocular collateral features exhibited distinct distribution patterns among the three groups suggesting that objective ocular-diagnosis technology may have value in the early screening of hypertension and hypertension complicated with coronary heart disease.