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Retinopathy (Hypertensive)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Hypertensive retinopathy is a condition that damages the retina of the eye due to high blood pressure. Chronically elevated blood pressure causes retinal vascular damage such as arteriolar vasoconstriction, arteriovenous nicking, and arteriosclerosis. More severe hypertension can cause hemorrhages, retinal ischemia (cotton wool spots), and/ or swelling of the optic nerve which requires emergency medical treatment. The primary goal in treatment is to lower the risk and progression of retinopathy through control of high blood pressure with medications, achieving and maintaining weight loss, and exercise. (See Hypertension.)
Non-DR Retinal Vascular Diseases
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Sobha Sivaprasad, Luke Nicholson, Shruti Chandra
Seven large epidemiologic population studies involving a total of 26,477 participants from the community, both with and without hypertension, studied various signs of hypertensive retinopathy from retinal photographs (39, 54–60). The authors found that signs of hypertensive retinopathy can be reliably identified with standardized examination of these photographs. Good reproducibility was noted for signs like retinal hemorrhages and microaneurysms (ĸ = 0.80–0.99) and fair reproducibility for arteriovenous nicking and focal arteriolar narrowing (ĸ = 0.40–0.79) (59, 61). Using digitized photographs, the assessment of vessel diameter narrowing had high reproducibility in four of the seven population studies (59, 61). Signs of hypertensive retinopathy are common in people 40 years of age or older, even in those without a history of hypertension (44). These population studies estimated prevalence rates from 2% to 15% for various signs of retinopathy, in contrast to the report from the Framingham Eye Study that found a prevalence of less than 1% among participants who underwent an ophthalmoscopic examination with dilation (54, 55, 62). The incidence of hypertensive retinopathy is variable and is often confounded by the presence of retinal vascular diseases associated with comorbidities. The Beaver Dam Eye Study evaluated hypertensive retinopathy patients without confounding effect of coexistent vascular disease. The overall incidence of hypertensive retinopathy was about 15%, 8% showed retinopathy, 13% showed arteriolar narrowing, and 2% showed arteriovenous nicking (39).
2018 ESC/ESH Guidelines for the Management of Arterial Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Bryan Williams, Giuseppe Mancia, Wilko Spiering, Enrico Agabiti Rosei, Michel Azizi, Michel Burnier, Denis L. Clement, Antonio Coca, Giovanni de Simone, Anna F. Dominiczak, Thomas Kahan, Felix Mahfoud, Josep Redon, Luis M. Ruilope, Alberto Zanchetti, Mary Kerins, Sverre E. Kjeldsen, Reinhold Kreutz, Stéphane Laurent, Gregory Y.H. Lip, Richard McManus, Krzysztof Narkiewicz, Frank Ruschitzka, Roland E. Schmieder, Evgeny Shlyakhto, Konstantinos P. Tsioufis, Victor Aboyans, Ileana Desormais
The prognostic significance of hypertensive retinopathy by fundoscopy has been well documented [161]. Detection of retinal haemorrhages, microaneurysms, hard exudates, cotton wool spots, and papilloedema is highly reproducible, indicates severe hypertensive retinopathy, and is highly predictive of mortality [161,162]. In contrast, evidence of arteriolar narrowing, either focal or general, and arteriovenous nicking at early stages of hypertensive retinopathy have less predictive value [163], and limited interobserver and intraobserver reproducibility, even with experienced observers [164]. Fundoscopy should be performed in patients with grade 2 or 3 hypertension or hypertensive patients with diabetes, in whom significant retinopathy is more likely. Fundoscopy may be considered in other hypertensive patients. The increasing emergence of new techniques to visualize the fundus through smartphone technologies should increase the feasibility of more routine fundoscopy [165].
Ocular Manifestations in an Italian Cohort of Patients with Takayasu Arteritis
Published in Ocular Immunology and Inflammation, 2023
Rosanna Dammacco, Luca Cimino, Luca De Simone, Giovanni Alessio, Franco Dammacco
Among the 7 patients (14 eyes) with HR, the abnormalities were mild in 6 eyes (42.8%), consisting of generalized arteriolar narrowing in 2 eyes, focal arteriolar narrowing in 2 eyes, and arteriovenous nicking in the other 2 eyes. Moderate changes were detected in 6 eyes (42.8%) and included a heterogeneous array of variably shaped retinal hemorrhages, cotton wool spots, and microaneurysms. Finally, in 2 eyes (14.3%), clear signs of HR and swelling of the optic disc indicated malignant HR. For the purpose of comparison, Table 3 summarizes the most common abnormalities detected by FFA in the two groups of patients with TR and HR. Ocular ischemia is the obvious consequence of a reduced ocular blood flow caused by the restriction of the carotid artery. Interestingly, it has been reported that radial artery pulselessness can predict a reduced perfusion of the ipsilateral eye.32 In our cohort, 4 patients had absent or diminished pulses (Table 2), including 2 patients with radial artery pulselessness. As expected, signs of retinal hypoperfusion of the ipsilateral eye were recognized in both patients and were especially prominent in one of them.
Retinal Vascular and Anatomical Features in the Spontaneously Hypertensive Rat
Published in Current Eye Research, 2020
Yunxia Li, Qian Wang, Eric R. Muir, Jeffrey W. Kiel, Timothy Q. Duong
In humans, chronic high blood pressure can lead to hypertensive retinopathy, exhibiting characteristic fundus pathology, arteriolar narrowing,29 a lower number of perifoveal arterioles and venules,30 and decreased capillary density in the perifoveal network in tandem with decreased capillary flow velocity in the retina.31 Moreover, arteriovenous nicking, vascular occlusion and microaneurysms have been reported in humans, but these pathologies were not observed in 40-week SHR animals. The absence of arteriovenous nicking in SHR is likely due to the differences in retinal vascular organization between rats and humans since rats do not have significant crossing of arterial and venous vessels. The absence of vascular occlusion and microaneurysms in SHR could be due to the differences in species and/or severity of the hypertension.
Increased rate of any retinopathy risk in patients with masked hypertension
Published in Clinical and Experimental Hypertension, 2020
Timuçin Yıldırım, Selçuk Özkan, Ömer Çağlar Yılmaz, Bunyamin Yavuz
Baseline characteristics in patients and controls are presented in Table 1. Of the 179 subjects included in this study, 55 (11.6%) participants had signs of retinopathy (Figure 1). Of the specific lesions detected, 27 (15.0%) had mild-generalized retinal arteriolar narrowing, 20 (11.1%) definite focal narrowing and arteriovenous nicking, seven (3.91%) retinal hemorrhage, exudate, and cotton-wool spots, and one (0.05%) papilledema. Office diastolic BP (78.6 ± 6.4 vs 74.6 ± 6.4), office heart rate (72.5 ± 11.2 vs 72.8 ± 11.5) were similar in patients with masked hypertension and in controls. 24-H systolic BP (130.1 ± 10.2 vs 120.9 ± 5.6, p < .001), 24-H diastolic BP (79.1 ± 8.1 vs 66.5 ± 6.5, p = .031), ambulatory daytime systolic BP (138.9 ± 7.8 vs 124.1 ± 5.5, p = .032), ambulatory daytime diastolic BP (84.8 ± 8.5 vs 69.4 ± 6.07, p = .01), ambulatory nighttime systolic BP (124.4 ± 13.3 vs 109.3 ± 4.6, p < .001), ambulatory nighttime diastolic BP (73.01 ± 12.5 vs 64.5 ± 6.3, p < .001), 24-H heart rate (76.6 ± 5.4 vs 75.3 ± 7.1, p = .04), office systolic BP (124.4 ± 3.07 vs 119.8 ± 4.5, p = .02), in patients with masked hypertension was significantly higher than in controls. Office Blood Pressure and ABPM parameters were demonstrated in Table 2.