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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.)
Autoimmune conditions
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
Fundoscopy shows optic disc swelling consistent with papilloedema. In optic disc atrophy, the optic disc would appear shrunken and paler. Hypertensive retinopathy is due to chronic excessive hypertension, and changes to the retina include arteriolar narrowing, arteriovenous crossings, cotton wool spots, vessel sclerosis and haemorrhage.
Non-DR Retinal Vascular Diseases
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Sobha Sivaprasad, Luke Nicholson, Shruti Chandra
Black people of African descent are known to have high prevalence of hypertensive retinopathy. This is likely secondary to increased prevalence of hypertension itself among blacks. Wong et al. examined racial differences in the prevalence of and risk factors for hypertensive retinopathy in a population-based sample of 1,860 African Americans and 7,874 white persons, aged 49–73 years, without diabetes (63). The retinal photographs of either eye of the subjects were evaluated for signs of hypertensive retinopathy. The prevalence of retinopathy was twice as high in African Americans than in whites (7.7% versus 4.1%, age- and gender-adjusted odds ratio [OR] 2.03, 95% confidence intervals [CI] 1.65, 2.49). After controlling for 6-year mean arterial blood pressure, use of antihypertensive medications and left ventricular hypertrophy by electrocardiogram (ECG) criteria, the excess prevalence of retinopathy in African Americans was reduced by 40% (adjusted OR 1.61, 95% CI 1.26, 2.06) (63). Variations in the prevalence of specific signs of hypertensive retinopathy according to age and sex have not been consistently demonstrated.
Association between Hyperhomocysteinemia and Hypertensive Retinopathy in a Chinese Han Population
Published in Current Eye Research, 2021
Hypertensive retinopathy (HR) is a complication of hypertension that can cause serious morbidity and mortality. Around 1.13 billion people worldwide are affected by hypertension,1 which is expected to affect one third of the world’s population by 2025.2 More than 330 million people in China currently suffer from hypertension.3 The severity of HR is related to the degree of hypertension and its various ocular complications. Its pathophysiology includes acute changes such as optic disc swelling, and chronic changes such as intimal thickening, hyaline degeneration, retinal hemorrhage, hard exudates, optic nerve ischemia, and serous retinal or retinal pigment epithelium detachment.4 Treatment of HR might thus reduce hypertensive optic neuropathy and suprachoroidal hemorrhages during ophthalmic surgery. In this study, we hypothesized that interventions targeting the risk factors of HR could help to reduce the occurrence of HR and its complications.
New Insights into Diabetic and Vision-Threatening Retinopathy: Importance of Plasma Long Pentraxine 3 and Taurine Levels
Published in Current Eye Research, 2021
Hülya Güngel, Füsun Erdenen, Isil Pasaoglu, Duygu Sak, Tülin Ogreden, Ilkay Kilic Muftuoglu
PTX-3 is one of the endothelium-specific inflammatory cytokines, representing the tissue inflammatory response, especially the one involving the vascular bed, and may reflect the inflammatory status of the vasculature. PTX-3 enhances the procoagulant effect of the endothelial cells and reduces the endothelial repair by disabling the effect of the fibroblast growth factor. It may modulate inflammation-associated tissue damage and offer protection against AS. The maximum plasma level of PTX-3 varies depending on the time of the vascular event.7 Clinical studies have shown conflicting results about the role of PTX-3 as an active mediator of endothelial dysfunction, AS, and ischemic events.22 PTX-3 may have a dual role in the activation of pro- and anti-inflammatory pathways as determined by time, space, and environmental signals. The association of PTX-3 and DR is correlated with an important retinal microvascular dysfunction, characterized by capillary leakage or closure, leading to ischemia.23 Reportedly, PDR patients had the highest PTX-3 levels.24 Further, high PTX-3 levels are related to vascular dysfunction in patients with type 2 DM. The perfusion pressure of the precapillary arterioles, that suddenly rise for any reason, causes damage to the vessel walls as a result of impaired autoregulatory mechanism. It is characterized by soft exudates that form sclerosis in the precapillary arteriole, creating an obstruction in the vascular lumen and ischemia in the nerve fiber layer. This mechanism is known to cause hypertensive retinopathy.25
Can ocular OCT findings be as a predictor for end-organ damage in systemic hypertension?
Published in Clinical and Experimental Hypertension, 2020
Engin Ersin Simsek, Hatice Selen Kanar, Batur Gonenc Kanar, Huseyin Cetin, Aysu Arsan, Mustafa Kursat Tigen
The vascular changes in HTRP are directly visible with fundoscopic evaluation and develop as a result of generalized arterial narrowing caused by autoregulation mechanism. With persistent elevated blood pressure, blood-retinal barrier may breakdown and RNFL ischemia develops. In this stage, cotton wool spots are seen related to focal RNFL ischemia (16). There are several HTRP classification systems according to fundoscopic alterations (17). Moderated to severe hypertensive retinopathy has a strong association with poor prognosis in patients with systemic hypertension (18,19). We also demonstrated a relation between EOD and SFCT. Patients with a higher number of target organ involvement had significantly lower SFCT while no significant decrease was noted in CMT, IP-GCC and pRNFL thicknesses with an increasing number of EOD. We suggest that adding SD-OCT to the funduscopic examination may help to determine the burden of EOD in systemic hypertension patients and might be used as a prognostic indicator in this patient group.