Hypertensive Retinal Changes Research Articles

Association between Retinal Microvascular Changes and Severity of Coronary Heart Disease in Hypertensive Patients

Background : The prevalence of coronary artery disease is increasing day by day. In many cases it is undiagnosed. Hypertension is one of the risk factors of coronary artery disease. Hypertension also causes some changes in retina which is easy to diagnose in clinical practice. So the aim of this study is to predict coronary artery disease by seeing hypertensive retinal changes.
 Methods: A total of 100 patients with hypertension presenting to the emergency department with ischemic chest pain who underwent coronary angiography were studied. Presence or absence of coronary artery disease was determined. Optic fundi were assessed for hypertensive retinopathy which were photographed.
 Results: Mean ± SD age of the study population was 56.23±10.76 years. There were 75 men (75%) and 25 women (25%). Prevalence of coronary artery disease and hypertensive retinopathy were 84% and 44% respectively. There was association between coronary artery disease and retinopathy (P< 0.017). Age (P= 0.019), smoking (P=0.011) and dyslipidaemia (0.039) were identified as risk factors for coronary artery disease.
 Conclusion: Important observations from this study are that hypertensive retinopathy has an association with coronary artery disease. Retinal change can be used in predicting coronary artery disease in patients with hypertension which can be used as screening tool for diagnosing coronary artery disease in resource poor settings.
 University Heart Journal 2022; 18(2): 93- 97

A literature review of hypertensive retinopathy: systemic correlations and new technologies.

Hypertensive retinopathy (HR) is the most common ocular manifestation of systemic arterial hypertension. This paper aims to summarize the current knowledge of HR, reviewing its classical features, such as epidemiology, pathophysiology, clinical manifestations, classifications, management and the most significant systemic correlations. We also provide an update on the latest advances in new technologies focusing on novel instrumental classifications. A literature search was performed to identify articles regarding HR listed in Embase, PubMed, Medline (Ovid) and Scopus database up to 1 December 2021. The reference lists of the analyzed articles were also considered a source of literature information. The following keywords were used in various combinations: hypertensive retinopathy, hypertension and eye, hypertensive retinopathy and systemic correlations, optical coherence tomography (OCT) and hypertensive retinopathy, optical coherence tomography angiography (OCTA) and hypertensive retinopathy, adaptive optics (AO) and hypertensive retinopathy. The authors analyzed all English articles found using the aforementioned keywords. All the publications were thoroughly reviewed to create a detailed overview of this issue. HR signs have a significative association with cardiovascular, cerebrovascular and other systemic diseases. Patients with arteriosclerotic changes and, at the same time, severe HR, are at increased risk for coronary disease, peripheral vascular disease, stroke and dementia. HR is even now diagnosed and classified by its clinical appearance on a fundoscopic exam that is limited by interobserver variability. New technologies, like OCT, OCTA, AO and artificial intelligence may be used to develop a new instrumental classification that could become an objective and quantitative method for the evaluation of this disease. They could be useful to evaluate the subclinical retinal microvascular changes due to hypertension that may reflect the involvement of other vital organs. The eye is the only organ in the human body where changes in the blood vessels due to systemic hypertension can be studied in vivo. All doctors should be familiar with this disease because it has been largely demonstrated that signs of HR are correlated to patient's health and mortality. Researchers should develop a new common, standardized, and objective method to assess hypertensive retinal changes; new technologies may have a significant role in this field. This review takes most of the literature published so far, including the OCTA studies in order to stimulate new points of reference to standardize parameters and new diagnostic markers of this disease.

Evaluation of maternal ophthalmic artery Doppler indices and its correlation with fundoscopic changes in normotensive and pre-eclamptic pregnancies: A comparative study

Background: Preeclampsia is a multisystem disease characterized by the development of hypertension after 20 weeks of gestation in a previously normotensive woman with the presence of proteinuria, severity leading to target organ injury, including liver, kidney, heart, lungs, brain and pancreas. We evaluated the ophthalmic artery Doppler indices (PSV, EDV, PI, RI) in normotensive and in pre-eclampic pregnancies and correlated the Doppler indices changes with fundoscopic findings. Materials and methods: Orbital Ultrasonography was performed on the pregnant women who developed high blood pressure after 20 weeks of gestation and on the normal pregnant women as control and the Doppler indices of ophthalmic artery were determined. Fundoscopic examination of the patients was done with direct ophthalmoscope. Hypertensive Retinal changes observed in both eyes were taken as positive findings. Results: The study showed that PSV, RI and PI and S/D ratio were reduced in pre-eclampic patients when compared with healthy normotensive pregnant women while EDV was increased in pre-eclampic patients when compared with healthy normotensive pregnant women. Statistically significant relationship among Doppler parameters namely PSV, EDV, PI, RI, S/D values between normotensive and pre-eclampic patients was noted. Fundoscopic changes were noted among sever pre-eclampsia patients. Conclusions: Ophthalmic artery Doppler Ultrasonography can detect pre-eclampsia in early stages when compared to fundoscopy and is a cheap, noninvasive, readily available, safe, and reliable tool for evaluation of the central hemodynamic changes in normal pregnancy, and even more so in PE.

Correction of hypertensive retinal changes in rats with Semax

Currently, there are no drugs for the specific treatment of hypertensive retinal changes. The main therapy is for the treatment of a systemic disease – hypertensive disease. Therefore, the search for ways of specific pharmacological correction of hypertensive retinal changes is of great interest. The aim of the study: To evaluate the correction possibility of retinal injuries with Semax in a rat model of hypertensive neuroretinopathy. Materials and methods: The model was performed by injection of N-nitro-L-arginine methyl ester (L-NAME) at a dose of 1.25 mg/100 g of rat mass within 28 days and a single increase in intraocular pressure (IOP) to 110 mmHg for 5 min. The retinoprotective effect of Semax at a dose of 7.2 μg/100 g of rat mass, in comparison with Picamilon at a dose of 3 mg/100 g of rat mass, was estimated by laser Doppler flowmetry (LDF) and electroretinography (ERG). Results: The use of Semax led to an increase in retinal perfusion by 62.7%, p < 0.05, in comparison with the group with the model, and by 9.9%, p < 0.05, in comparison with Picamilon; an increase in the b/a coefficient by 31.4% in comparison with the group with the model, p < 0.05, and by 14.6%, p < 0.05 in comparison with Picamilon. Conclusion: The neuroretinoprotective effect of Semax in correction of hypertensive retinal changes in rats may be due to the presence of neuroprotective, neurometabolic, antioxidant and endothelioprotective effects in Semax. Thus, Semax can be a promising agent in hypertensive neuroretinopathy treatment.

Retinal findings in chronic kidney disease patients on hemodialysis

Background Chronic kidney disease (CKD) is an irreversible condition that leads to progression to end-stage renal disease that requires hemodialysis or kidney transplantation for patient survival and these patients are at risk of developing many complications. In the present study, the retinal findings in CKD patients on hemodialysis are evaluated. Patients and methods This is a cross-sectional noninterventional study that was carried out on CKD patients on hemodialysis for at least 3 months in the Nephrology Unit, Tanta University, Egypt; 160 eyes of 80 patients were included over 6 months. A complete ophthalmic evaluation was performed. Color fundus and spectral domain optical coherence tomography were performed at presentation. Results The visual acuity ranged from 6/6 to 6/18 in 80 eyes, which represents 50%, from 6/24 to 6/60 in 62 eyes, which represents 38.75%, and from less than 6/60 to perception of light in 18 eyes, which represents 11.25%. Fundus examination revealed that eight eyes were normal (5%). Hypertensive retinal changes occurred in 82 eyes with variable degrees of retinopathy. Diabetic retinopathy was found in 30 (18.75%) eyes and macular degeneration was detected in 20 (12.5%) eyes. Retinal vasculitis occurred in two (1.25%) eyes, branch retinal vein occlusion was detected in six (3.75%) eyes, glaucomatous optic neuropathy was found in eight (5%) eyes and central retinal artery occlusion occurred in four (2.5%) eyes. Conclusion The most common visual problems in hemodialysis patients that lead to visual loss are hypertensive and diabetic retinopathy. Hence, it is mandatory to screen fundus changes in CKD to prevent loss of vision.

Hypertensive retinal changes: It’s prevalence and associations with other target organ damage

Objectives: This study enlightens association of different cerebrovascular, cardiovascular, and renal morbidities with hypertensive retinopathy which is very much relevant in the present scenario, especially in India, where the prevalence of hypertension is very high. The objectives of the study were to estimate the prevalence, association, and severity of hypertensive retinal changes among patients with other target organ damage (TOD) such as cardiovascular or cerebrovascular or renal morbidities. Material and Methods: A cross-sectional descriptive observational study was carried out after doing systemic random sampling involving 416 study participants having a history of hypertensive cerebrovascular, cardiovascular, and renal damages include history of stroke, acute coronary syndromes, left ventricular hypertrophy, and chronic kidney disease which were examined by direct ophthalmoscopy findings and classified according to the Scheie classification throughout the past 1 year in OPD of our institution. Results: Hypertensive retinopathy was present in 259 patients (62.25%) out of 416 participants (Grade I: 13.5%, Grade II: 26.9%, Grade III: 18.5%, and Grade IV: 3.4%). Among the variables associated with hypertensive retinopathy, it was seen that 209 (63.3%) subjects present with features of hypertensive retinopathy are more than 50 years of age. No significant association was found between hypertensive retinopathy and presence or absence of cardiovascular morbidities, cerebrovascular morbidities, and renal morbidities. However, the subgroup analysis shows that significant association was found between Grade IV hypertensive retinopathy with renal morbidities (odds ratio [OR] = 5.83 at 95% CI, P = 0.002) and Grade I retinopathy with cerebrovascular morbidities (OR = 7.09 at 95% CI, P = 0.000). Conclusion: Severe grades of retinopathy can be an indicator of renal morbidity, whereas earlier grades of retinopathy can be predictor of acute cerebrovascular events. Physicians should adopt holistic approach to evaluate TODs and screen them adequately in all hypertensives.

SUN-389 Consequences of Late Diagnosis of 11β-Hydroxylase Deficiency

Background: Steroid 11β-hydroxylase (CYP11B1) deficiency (11βOHD) is the second most common form of congenital adrenal hyperplasia (CAH). CAH is more likely to be missed in boys, particularly in patients with 11βOHD. Here, we report two boys with 11βOHD who presented late and the consequences of late diagnosis in them. Case presentation: Case 1: A-4-year-old boy presented with acne, appearance of axillary and pubic hair since the age of 3 years. Examination revealed tall stature (height z score: 4.6; predicted adult height <143 cm), hypertension (BP = 130/80 mmHg), P4, G3 (stretched phallic length: 8.5 cm) and nodular testes measuring 2 cc on right and 3 cc on left. His bone age was 13 years and had mild hypokalemia (serum potassium: 3.3 mEq/L). Serum total testosterone was elevated (263.13 ng/dl) with suppressed LH (0.04 mIU/ml). Serum 8:00 am cortisol was low (0.71 µg/dl) with markedly elevated corticosterone levels (>5000 ng/dl) and deoxycortisol (>1000 ng/dl). 17OHP was slightly elevated (334.73 ng/dl). Ultrasound scrotum revealed the presence of testicular adrenal rests (TARTs) in both testes. He had grade 1 hypertensive retinal changes and concentric left ventricular hypertrophy. Case 2: A-12-year-old presented with hypertensive encephalopathy. On examination he had normal stature for age (height: 138 cm; ≈predicted adult height =short), P4, G4 (stretched phallic length: 9 cm) and nodular testes measuring 4 cc on right and 6 cc on left. His bone age was 18 years and serum potassium was 2.67 mEq/L. Serum total testosterone was 229.77 ng/dl but LH was suppressed (0.03 mIU/ml). Serum 8:00 am cortisol level was low (0.39 µg/dl) with markedly elevated corticosterone levels (>5000 ng/dl) and deoxycortisol (>2000 ng/dl). 17OHP was slightly elevated (239.3 ng/dl). Ultrasound scrotum revealed bilateral TARTs. He had grade 1 hypertensive retinal changes and mild concentric left ventricular hypertrophy. Conclusion: Late diagnosis is common in boys with classic 11βOHD. It leads to disastrous complications such as hypertensive encephalopathy and/or hypertensive end organ damage, significantly compromises adult height potential and may have adverse impact on future fertility. Hence, early diagnosis of 11βOHD is essential.

Study of Microalbuminuria and hs-CRP in Non-obese and Obese Normotensive and Hypertensive Males and Evaluation of Microalbuminuria and hs-CRP Changes according to the Stages of Hypertension &amp; Grades of Hypertensive Retinal Changes

Aims & Objectives: To measure Microalbuminuria and hs-CRP in obese and non-obese male hypertensive patients and control groups and to correlate their levels with various stages of hypertension and different grades of hypertensive retinal changes. Men have higher prevalence of hypertension (29.4%) than women (26.5%)[1] Materials & Methods: The study was conducted among 60 normotensive individuals and 60 hypertensive individuals over a period of 6 months on OPD basis. All individuals were males in the age group of 40-60 years. Blood samples were collected and estimation of plasma glucose, urea, creatinine, lipid profile, hs- CRP and Urinary microalbumin were done. Results: The mean value of microalbuminuria and hs- CRP were higher among obese hypertensives than obese controls and were statistically significant. The changes in the mean value of microalbuminuria and hs-CRP within the different stages of hypertension were highly significant. Similarly the correlation of microalbuminuria and hs-CRP within the different grades of hypertensive retinal changes were highly significant. Conclusion: The serum level of hs-CRP and urinary microalbuminuria were elevated in hypertensive patients. The increase of both hs- CRP and microalbuminuria were significantly higher in obese hypertensives than non-obese hypertensives. Microalbuminuria & hs CRP levels correlate with various grades of hypertensive retinal changes.

AMALGAMATION OF MICRO AND MACROVASCULAR DAMAGE IN ESSENTIAL HYPERTENSION: THE COEXISTENCE OF RETINAL DAMAGE AND ARTERIAL STIFFNESS: 7A.02

Objective: The clinical and prognostic significance of hypertensive retinal changes, an established hypertension-related target organ damage (TOD), remains controversial. Therefore, we sought to investigate the relationship between retinal alterations and arterial stiffness, an index strongly correlated to increased cardiovascular morbidity and mortality. Design and Method: Our population consisted of 268 consecutive newly diagnosed, untreated, essential hypertensives (aged = 60 ± 13 years, 151 female, office blood pressure = 152/90 mmHg), without any history of cardiovascular disease or any other evident comorbidity. Venous blood samples were drawn for determination of metabolic profile and all participants underwent ambulatory blood pressure monitoring (ABPM). All subjects underwent fundoscopy examination and were distributed to five groups according to Sheie's grading system. (Groups A, B, C, D and E, for Sheie's scale 0, I, II, III and IV, respectively). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (c-f PWV) by means of a computerized method (Complior SP). Results: The five groups (including 39, 87, 99, 35 and 8 subjects respectively) did not differ with regard to age, gender, ABPM parameters and their metabolic profile (fasting glucose, serum lipids, uric acid) as well. However, hypertensives of higher Scheie's category exhibited significantly greater values of c-f PWV (8 ± 1.3, 9.1 ± 1.8, 9.4 ± 2.1, 9.8 ± 2 and 9.9 ± 2.4 m/sec respectively, p = 0.005). Notably, there was a statistically significant difference on pulse pressure among groups (53 mmHg, 60 mmHg, 63 mmHg, 65 mmHg and 67, respectively) (p = 0.04), another surrogate marker of arterial stiffness. Multivariable regression analysis showed that age, fundus classification and systolic arterial pressure were independent determinants of c-f PWV. Conclusions: In hypertensive subjects there is a progressive stiffening of the aorta in parallel with the evolution of the fundus lesions according to Scheie's scale. A possible explanation derives from the fact that same pathophysiological processes, like wall remodeling or endothelium impairment occur in small and in large vessels in hypertension.

Hypertensive retinal changes, a screening tool to predict microalbuminuria in hypertensive patients: a cross-sectional study

Studies have shown that hypertensive retinal changes (HRC) have a moderate accuracy in predicting microalbuminuria (MA) in elderly hypertensive patients (age >65 years). This study is an effort to identify a similar relationship in hypertensive patients aged <65 years. Eight hundred and seventy consecutive hypertensive patients (males, 460; females, 410) aged 18-65 years were assessed for their demographic characteristics and other laboratory variables. Patients with diabetes mellitus, metabolic syndrome and overt nephropathy were excluded. Optic fundi were assessed for HRC after pupillary dilatation, which were photographed. MA (albumin-creatinine ratio) was measured as an average of two non-consecutive overnight spot urine samples. Mean age was 45 +/- 13.4 years. Prevalence of MA and HRC was 36.7 and 38%, respectively. MA showed a strong association with HRC (P < 0.0001). Logistic regression identified the association between MA, duration of hypertension (HTN) (P = 0.016), smoking (P = 0.012) and elevated high-sensitivity C-reactive protein (HsCRP) (P = 0.032). HRC were associated with duration of HTN (P = 0.021) and smoking (P < 0.0001). Tests of accuracy for HRC as a predictor of MA showed sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio of a positive test and likelihood ratio of a negative test of 78%, 86%, 76%, 87%, 5.2 and 0.26, respectively. Area under the receiver operating characteristic curve was 81%. Similarly, the individual grades of HRC had a moderate predictive accuracy. Higher grades had higher predictive accuracy. Inter- and intra-observer correlation in interpreting HRC was acceptable. HRC of any grade have moderate accuracy in predicting MA and hence can be used as a cost-effective screening tool to predict MA especially in a resource-poor setting.

Incidence and significance of fundus changes in EPH gestosis

The authors examined 100 unselected pregnant women with EPH gestosis of different severity using the Keith-Wagener classification. In 52 women no fundus changes were observed; first-degree changes were seen in 32 women and second-degree changes in 10. Six gravidae presented with third or fourth-degree fundus changes. The average gestosis index was almost identical in the group without fundus changes and in the groups with first and second-degree hypertensive retinal changes, but significantly higher in the group with severe fundus changes (third or fourth degree). There was a clear correlation between the hypertensive fundus changes and blood pressure at the time of examination, in particular with regard to systolic blood pressure. An apparently normal fundus did not exclude the presence of a severe EPH gestosis; on the other hand severe retinal changes were sometimes seen in women with only mild EPH gestosis. Examination of the fundus in patients with EPH gestosis permits an objective assessment of vascular changes and provides a basis for further obstetric management.

Hypertensive Retinal Disease.

This book is constructed as the recollections and a brief resume of an internist's lifelong interest in the retinal vascular changes of hypertension. Consisting of only 44 pages, it can be read in a short time. It adds little to the specialist's knowledge and, though admittedly not comprehensive, it does emphasize the importance of careful fundus examination as a vital aid in the understanding of the vascular dynamics of hypertension. The illustrations are fundus drawings which graphically aid in illustrating the author's text; however the ophthalmologist might prefer fundus photographs. The material presented dates back to the author's recognition of hypertensive retinal changes in the 1930's. This journey into the past serves as a useful refresher for those internists who recall the early wonder of ophthalmoscopy in hypertension. The price for this limited amount of material seems high, although the print and paper are both of excellent quality.

Hypertensive Retinal Changes and Sympathectomy

Hypertensive Retinal Changes and Sympathectomy

Discussion on the Effect of Sympathectomy on Hypertensive Retinal Changes

Discussion on the Effect of Sympathectomy on Hypertensive Retinal Changes