Relationship of Hypertensive Retinopathy to Thoracic Aortic Atherosclerosis in Patients with Severe Arterial Hypertension

Abstract

Arterial hypertension complicated with atherosclerosis presents the most common cause of death in hypertensive patients. Eyes suffer vascular damage as a result of high blood pressure (BP) and these changes can be detected by funduscopy, although its role has recently been questioned. The aims of this study were to assess the prevalence of atherosclerotic plaques and other disorders of thoracic aorta by transesophageal echocardiography (TEE) in patients with severe arterial hypertension of at least 1 year duration and to analyze the association between aortic atherosclerotic plaques and hypertensive retinopathy. This was a prospective TEE study conducted on 56 hypertensive patients from September 2008 to January 2010. Mean patient age was 62.8 ± 8.2 years and 67.86% of them were women. Aortic atherosclerotic plaques were found on 96.4% of patients, whereas hypertensive retinopathy was present on 94.6% of them. The mean thickness of maximal atherosclerotic plaque found on each patient was 4.3 ± 1.9 mm and 28.6% of patients had ulcerative plaques, while descending aorta was the most common location of the lesions. Grade 1 and 2 hypertensive retinopathy was diagnosed in 14.3% and 80.3% of patients, respectively. Hypertensive retinopathy correlated highly with aortic atherosclerotic score (r = 0.76, p < 0.0001), as it correlated significantly with aortic plaque thickness (r = 0.69, p < 0.0001). Application of funduscopy should be encouraged since it is a noninvasive procedure that provides a good window of retinal arterioles. Hypertensive retinopathy, even in mild forms, should serve as a marker of atherosclerosis elsewhere in the organism.