A NEW study has revealed that intensive blood pressure treatment not only protects the heart and brain but also improves the eye’s tiny blood vessels. Patients receiving more aggressive blood pressure control showed healthier retinal microvasculature than those receiving standard care.
The Broader Role of Blood Pressure Treatment
The effects of blood pressure treatment extend beyond traditional cardiovascular outcomes. The retina offers a unique, non-invasive window into the body’s microcirculation , allowing researchers to observe early signs of hypertension-related damage. Until now, little was known about whether more intensive blood pressure treatment could reverse or improve these small vessel changes. The ESPRIT trial, conducted in China, provides the first strong evidence that tighter blood pressure targets may protect the delicate retinal microvasculature, offering fresh insights into the prevention of organ damage linked to hypertension.
Methods and Findings from the ESPRIT Trial
The study included 1,081 participants aged 50 years or older with high cardiovascular risk, randomly assigned to intensive treatment targeting systolic blood pressure (SBP) below 120 mm Hg or standard treatment targeting below 140 mm Hg. Over three years, retinal photographs were analysed to measure vessel calibre, density, and complexity.
Participants in the intensive group (n=555) showed increased arteriolar calibre, demonstrated by an arteriole-venule ratio (β = 0.16; 95% CI: 0.05–0.28; P = 0.005), and a central retinal arteriole equivalent (β = 0.14; 95% CI: 0.02–0.25; P = 0.02). The treatment also enhanced arteriolar complexity and density while reducing vessel tortuosity. No significant effects were found for venular calibre, and no heterogeneity was observed across age, sex, or comorbidity subgroups.
Clinical Implications and Future Perspectives
These results mark an important step in understanding how intensive blood pressure treatment can preserve microvascular health. The study provides the first evidence that tighter blood pressure control can improve retinal and systemic microcirculation, potentially reducing the long-term burden of hypertension-mediated organ damage. Future studies are expected to explore whether similar benefits extend to other microvascular systems, such as the kidneys and brain.
Reference
Bakhoum MF et al. The retinal fundus verdict on intensive blood-pressure therapy: lower is better. Journal of the American College of Cardiology. 2025;86:17.
