Presence Of Hypertensive Retinopathy Research Articles

Comparison of 50° handheld fundus camera versus ultra-widefield table-top fundus camera for diabetic retinopathy detection and grading.

To compare the performance of a handheld fundus camera with standard 50° visual field to ultra-widefield (UWF) table-top fundus camera in diabetic retinopathy (DR) detection and grading. Patients affected by diabetes mellitus and referred to our diabetic retinopathy clinic were enroled and underwent fundus photography in mydriasis. All photos were taken using the ultra-widefield table-top fundus camera Zeiss Clarus™ 500 (four fields per eye) and the Optomed Aurora® handheld fundus camera (3 fields per eye). The following parameters were analysed: the gradability of the images, the grade of DR, and diabetic maculopathy (DM), the presence of hypertensive retinopathy (HR) and the presence of other ocular diseases. We enroled 759 eyes of 384 diabetic patients and analysed 5313 fundus photos. The handheld fundus camera obtained a sensitivity of 84.2% and specificity of 95.4% for referable cases. Moreover, it obtained, compared to UWF, an almost perfect agreement with linear weighting for DR, DM and HR (k = 0.877, k = 0.854, and k = 0.961, respectively). The lowest sensitivity was achieved for proliferative DR (58.7% sensitivity, 100% specificity). Optomed Aurora® handheld fundus camera imaging showed a strong agreement compared to UWF in grading DR, considering all DR and DM grades, in mydriasis. However, the use of UWF imaging increases the detection of referable eyes.

Handheld Fundus Camera for Diabetic Retinopathy Screening: A Comparison Study with Table-Top Fundus Camera in Real-Life Setting.

The aim of the study was to validate the performance of the Optomed Aurora® handheld fundus camera in diabetic retinopathy (DR) screening. Patients who were affected by diabetes mellitus and referred to the local DR screening service underwent fundus photography using a standard table-top fundus camera and the Optomed Aurora® handheld fundus camera. All photos were taken by a single, previously unexperienced operator. Among 423 enrolled eyes, we found a prevalence of 3.55% and 3.31% referable cases with the Aurora® and with the standard table-top fundus camera, respectively. The Aurora® obtained a sensitivity of 96.9% and a specificity of 94.8% in recognizing the presence of any degree of DR, a sensitivity of 100% and a specificity of 99.8% for any degree of diabetic maculopathy (DM) and a sensitivity of 100% and specificity of 99.8% for referable cases. The overall concordance coefficient k (95% CI) was 0.889 (0.828–0.949) and 0.831 (0.658–1.004) with linear weighting for DR and DM, respectively. The presence of hypertensive retinopathy (HR) was recognized by the Aurora® with a sensitivity and specificity of 100%. The Optomed Aurora® handheld fundus camera proved to be effective in recognizing referable cases in a real-life DR screening setting. It showed comparable results to a standard table-top fundus camera in DR, DM and HR detection and grading. The Aurora® can be integrated into telemedicine solutions and artificial intelligence services which, in addition to its portability and ease of use, make it particularly suitable for DR screening.

Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients in a Tertiary Hospital of Gandaki Province of Nepal

Introduction: Hypertensive retinopathy is one of the major complications of hypertension. The presence of hypertensive retinopathy may be an indicator of the presence of other complications too. This study aimed to determine the prevalence and risk factors of hypertensive retinopathy in hypertensive patients in a tertiary care hospital in Nepal. Methods: This was a hospital-based cross-sectional study conducted among 95 hypertensive patients aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and hypertensive retinopathy was graded according to Keith-Wagener-Barker classification. Statistical analysis was carried out using Epi-info 7. Results: The mean age of the study sample was 59.74±15.11 years. The prevalence of hypertensive retinopathy was 38.95%. Among the patients with hypertensive retinopathy, the prevalence of grade I, II, III, and IV retinopathies were 7.36%, 17.89%, 10.52%, and 3.15% respectively. There was a statistically significant association between hypertensive retinopathy and controlled blood pressure and treatment of hypertension. However, there was no statistically significant association between hypertensive retinopathy and gender, duration of hypertension, residence, family history, history of smoking, and diet. Conclusion: Uncontrolled blood pressure and untreated patients of hypertension were the significant risk factors for hypertensive retinopathy. Early diagnosis and treatment of hypertension are essential to prevent loss of vision.

Hypertension, retinopathy, and acute kidney injury in dogs: A prospective study.

BackgroundSystemic hypertension (SH) is a potential complication of acute kidney injury (AKI) in dogs.ObjectiveTo describe the prevalence of SH and hypertensive retinopathy in dogs with AKI, to investigate the relationship between SH and severity of AKI and to assess possible factors associated with SH.AnimalsFifty‐two dogs with AKI.MethodsProspective observational study of dogs presenting to a tertiary referral center that fulfilled the International Renal Interest Society (IRIS) guidelines for the diagnosis of AKI. Systolic blood pressure measurement, urine protein/creatinine ratio (UPCR), urine output, presence of hypertensive retinopathy and fluid overload (FO), survival to discharge and duration of hospitalization were subsequently assessed. The prevalence of SH was calculated and the relationship between SH and recorded factors was examined by nonparametric statistics.ResultsThe prevalence of SH (≥160 mm Hg) on admission or during hospitalization was 75% (39/52) and in 56% (22/39) of cases this was severe (≥180 mm Hg). Sixteen percent (7/43) of dogs had evidence of hypertensive retinopathy and 77% (24/31) dogs had UPCR >0.5. Forty‐two percent (22/52) dogs had FO on admission or during hospitalization. There was no association between SH and IRIS AKI grade, oligo/anuria, survival to discharge, duration of hospitalization or proteinuria. Dogs with FO on presentation were more likely to be hypertensive at admission compared to dogs without FO (P = .02). Dogs that did not survive to discharge were more likely to have FO (P = .007).Conclusions and Clinical ImportanceSystemic hypertension is common in dogs with AKI. Systemic hypertension might be associated with FO, which itself is associated with nonsurvival. Monitoring for SH and FO is therefore warranted in dogs with AKI.

Relationship between nocturnal blood pressure profiles and the presence and severity of hypertensive retinopathy

Abstract Introduction Non-dipper and extreme dipper blood pressure (BP) profiles are associated with a worse cardiovascular prognosis. The relationship between nocturnal BP profile and hypertensive retinopathy (HR) is not fully established. Aim To assess the association between the prevalence and severity of HR and nocturnal BP. Methods We prospectively studied hypertensive patients who underwent 24-hour ambulatory BP monitoring. The population was divided into two groups according to the presence or absence of lesions and compared according to baseline characteristics, nocturnal BP profile (dippers, non-dippers, inverted dippers/risers and extreme dippers) and mean nocturnal systolic (SBP) and diastolic (DBP) BP values. The presence and severity of HR were assessed using the Scheie classification. The relationship between nocturnal SBP and DBP values (and nocturnal BP profile) and the prevalence and severity of HR was determined. Results Forty-six patients (46% male, aged 63±12 years) were analyzed, of whom 91% (n=42) were under antihypertensive treatment. Seventy percent (n=33) had uncontrolled BP. HR was diagnosed in 83% (n=38). Patients with HR had higher mean systolic nocturnal BP (151±23 vs. 130±13 mmHg, p=0.008). Patients with greater HR severity (Scheie stage ≥2) had higher nocturnal BP (153±25 vs. 140±16 mmHg, p=0.04). There was no statistically significant association between DBP and nocturnal BP patterns and HR. Conclusions The prevalence and severity of HR were associated with higher nocturnal SBP. No relationship was observed between nocturnal BP profile and the presence of HR.

Relação entre o perfil tensional noturno e a prevalência e gravidade da retinopatia hipertensiva

IntroductionNon‐dipper and extreme dipper blood pressure (BP) profiles are associated with a worse cardiovascular prognosis. The relationship between nocturnal BP profile and hypertensive retinopathy (HR) is not fully established. AimTo assess the association between the prevalence and severity of HR and nocturnal BP. MethodsWe prospectively studied hypertensive patients who underwent 24‐hour ambulatory BP monitoring. The population was divided into two groups according to the presence or absence of lesions and compared according to baseline characteristics, nocturnal BP profile (dippers, non‐dippers, inverted dippers/risers and extreme dippers) and mean nocturnal systolic (SBP) and diastolic (DBP) BP values. The presence and severity of HR were assessed using the Scheie classification. The relationship between nocturnal SBP and DBP values (and nocturnal BP profile) and the prevalence and severity of HR was determined. ResultsForty‐six patients (46% male, aged 63±12 years) were analyzed, of whom 91% (n=42) were under antihypertensive treatment. Seventy percent (n=33) had uncontrolled BP. HR was diagnosed in 83% (n=38). Patients with HR had higher mean systolic nocturnal BP (151±23 vs. 130±13 mmHg), p=0.008). Patients with greater HR severity (Scheie stage ≥2) had higher nocturnal BP (153±25 vs. 140±16 mmHg, p=0.04). There was no statistically significant association between DBP and nocturnal BP patterns and HR. ConclusionsThe prevalence and severity of HR were associated with higher nocturnal SBP. No relationship was observed between nocturnal BP profile and the presence of HR.

Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients

Background: Hypertensive retinopathy is one of the major complications of hypertension. Presence of hypertensive retinopathy may be an indicator of presence of other complications of hypertension, commonly nephropathy. Subjects and methods: This study was carried out in OPD of Hypertension and Research Center, Rangpur, Bangladesh. It was a cross sectional study, systemic sampling method was used to generate the sample of 384 patients. Results: Out of 313 hypertensive patients, male were found preponderance (66.1% vs. 33.9%), mean age was 51.80 years. 29.4% (92) patients had hypertensive retinopathy of different grades. Majority (14.7%) of the patient had grade 1 hypertensive retinopathy. Average time required to develop retinopathy was 6.73 years (minimum 3 month, maximum 30 years). Mean age of the patients with hypertensive retinopathy was 55.10 years. Hypertensive retinopathy was significantly higher in >50 years age than <50 years age (68.48% vs. 31.52%) (P value=0.0004779), male sex (64.1% vs. 35.9%) and higher in those with duration of hypertension more than 5 years (34.56% vs. 23.84%) (P-value=0.00000251). Other target organ damage (IHD, stroke and CKD) was more in those with retinopathy than without retinopathy patients (21.73% vs. 19.90%). Conclusion: In our study more than one fourth of the hypertensive patients had hypertensive retinopathy. Male sex, increasing age (>60 years) and longer duration of hypertension (>5 years) were positively correlated with hypertensive retinopathy.

ESSENTIAL ARTERIAL HYPERTENSION AND RISK FACTORS ASSOCIATED WITH HYPERTENSIVE NEPHROPATHY

Arterial hypertension is a major risk factor that predisposes to cardiovascular disorders and is responsible for most of the morbidity and mortality in patients. Hypertension is closely associated with the kidney, because kidney disease can be both the cause and consequence of increased blood pressure. Elevation of blood pressure is a strong independent risk factor for hypertensive nephropathy and development of ESRD. The pathogenesis of ischemic hypertensive nephropathy (IHN) is multifactoral, and in addition to blood pressure other factors contribute to the development of this renal pathology and its progression to end-stage renal disease. These include obesity, smoking, male gender and other still unknown risk factors. The aim of this paper was to analyse the association between essential arterial hypertension and renal hypertensive disease and prevalence of other atherosclerotic risk factors in patients with developed hypertensive renal disease. In this prospective cross sectional study 283 patients of both genders with diagnosed essential hypertension and hypertensive renal disease were analysed. The anamnestic data related to age, duration of hypertension, history of smoking, presence of hypertensive retinopathy, hypertrophy of the left chamber and data about previous renal diseases were collected through conversation and medical documentation. The clinical examination comprise determination of blood pressure, body mass index (BMI), lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides), serum urea and creatinine, urine, albumin and protein concentration. The total number of 283 patients (185 males and 98 females) with HN was analyzed. The analysis revealed significantly higher proportion of males aged over 60 years with IHN. The mean age of examined hypertensive patients with IHN is 62.6±8.8 years with duration of hypertension 19.8±5.9 years. All examined patients had hypertensive retinopathy and hypertrophy of the left chamber. The majority of the examined patients (78.6%) with IHN were overweight with BMI 25-30kg/m. Dyslipidemia was registered in 75% and smoking in 75% of hypertensive patients with IHN. The most common lipid disorders were hypertrigliceridemia with hypercholesterolemia found in 42.1% and combined dyslipidemia in 25.8%. Family history of arterial hypertension (AH) was registered in all patients with IHN. The correlation analysis revealed a significant positive association between family history of HTA (r=0.62, p<0.05), smoking (r=0.53, p<0.05) and combined dyslipidemia (hypertrigliceridemia and hypercholesterolemia) (r=0.45, p<0.05) with occurrence of IHN. Hypertensive nephropathy predominatly occurs in older hypertensive males with developed hypertensive microand macrovascular complications. The family history of AH, smoking and lipid disorders, especially combined dyslipidemia are very common risk factors associated with hypertensive nephropathy. Prevention and therapy of these risk factors is an important task in reduction of hypertensive nephropathy. Acta Medica Medianae 2014;53(4):15-21.

CORRELATIONS BETWEEN SARCOPENIA AND HYPERTENSIVE TARGET ORGAN DAMAGE IN A TURKISH COHORT

Aims: To investigate a possible correlation between skeletal muscle mass and hypertensive target organ damage.Materials and Methods: A total of 365 hypertensive patients aged > 18 years were included ( 221 females; 144 males). Exclusion criteria were: diabetes; hypo- or hyperthyroidism; immobilisation; leg amputation; dehydration; cancer diagnosis; renal insufficiency with GFR of < 60 ml/dk/1.73 m2; and hormone replacement therapy. All patients who participated in the study were examined for the presence of hypertensive retinopathy and nephropathy and divided into four groups according to age and sex (group 1 = females aged < 60 years; group 2 = females aged > 60 years; group 3 = males aged < 60 years; and group 4 = males aged > 60 years). The diagnosis of hypertensive nephropathy and retinopathy was based on spot urine microalbuminuria/creatinine ratio and opthalmoscopy, examination respectively. Body composition was evaluated using bioimpedance analysis (BIA). Fullbody skeletal muscle mass (SMM) and SMM index (SMMI) were used as indicators of skeletal muscle mass.Results: As expected, female and elderly subjects showed a decreased skeletal muscle mass and increased fat mass compared to males and younger subjects. In the overall cohort, a negative correlation was found between skeletal muscle mass and both hypertensive retinopathy and nephropathy. Subgroup analysis revealed a linear correlation between increased SMM and a decreased risk of hypertensive retinopathy. Patients with a spot urine microalbuminura / creatinine ratio of ≥ 30 had a lower SMM and a lower SMMI than patients with a ratio of < 30.Conclusion: In the present cohort, sarcopenia mainly due to aging was associated with an increased rate of hypertensive target organ damage in the form of hypertensive retinopathy and nephropathy.

Hypertensive Target Organ Damage in Ghanaian Civil Servants with Hypertension

BackgroundLow levels of detection, treatment and control of hypertension have repeatedly been reported from sub Saharan Africa, potentially increasing the likelihood of target organ damage.MethodsA cross-sectional study was conducted on 1015 urban civil servants aged≥25 years from seven central government ministries in Accra, Ghana. Participants diagnosed to have hypertension were examined for target organ involvement. Hypertensive target organ damage was defined as the detection of any of the following: left ventricular hypertrophy diagnosed by electrocardiogram, reduction in glomerular filtration rate, the presence of hypertensive retinopathy or a history of a stroke.ResultsOf the 219 hypertensive participants examined, 104 (47.5%) had evidence of target organ damage. The presence of target organ damage was associated with higher systolic and diastolic blood pressure levels. The odds of developing hypertensive target organ damage was five to six times higher in participants with blood pressure (BP)≥180/110 mmHg compared to those with BP<140/90 mmHg, and there was a trend to higher odds of target organ damage with increasing BP (p = 0.001). Women had about lower odds of developing target organ damage compared to men.ConclusionsThe high prevalence of target organ damage in this working population associated with increasing blood pressure, emphasises the need for hypertension control programs aimed at improving the detection of hypertension, and importantly addressing the issues inhibiting the effective treatment and control of people with hypertension in the population.

White-coat hypertension and target-organ damage

The relationship between arterial hypertension cardiovascular and cerebrovascular events are well-known as well as to target-organ damage. It is not yet definitively clear whether white-coat hypertension (WC-HT) constitutes a risk factor. We have studied the relationship between WC-HT and target-organ damage in 60 subjects (32 M, 28 F; mean age 64±5.2). WC-HT was defined when clinical blood pressure>140/90 mmHg and average daytime ambulatory blood pressure (30 pts) or home blood pressure (30 pts) ≤120/80 mmHg. Target-organ damage was assessed using the left ventricular mass index (LVMI) measured by echocardiography; the thickness of the intima-media complex (IMT) measured at the common carotid 1 centimetre from the flow-divider; diameter of abdominal aorta determined by echography; ventricular arrhythmias (couplets, ventricular tachycardia and R-on-T phenomena) by dynamic ECG; presence of hypertensive retinopathy. Patients smokers and/or with diabetes mellitus, hyperlipidemia, history of coronary disease, cerebrovascular disease, peripheral arterial disease, were excluded from the study. All patients were examined at the beginning of the study and after 24 months. data refers to 55 subjects. 5 subjects, all by home blood pressure, developed arterial hypertension. The left ventricular mass was tested in 40 patients who had a good quality echocardiogram. The diameter of the abdominal aorta was measured in 58 subjects. In the two-year follow-up there were no non cardiovascular and/or cerebrovascular events. 1) white-coat hypertension does not constitute a risk factor in the development of target-organ disease and/or cerebrovascular and cardiovascular events. 2) However, it is necessary to keep checking white-coat hypertension subjects because they could develop arterial hypertension. 3) ABPM is the more reliable method compared to home blood pressure.(See Table)

Partial recovery of renal function in black patients with apparent end-stage renal failure due to primary malignant hypertension.

We report the largest series in which 12 out of 54 patients with primary malignant hypertension requiring dialysis recovered sufficient renal function to allow withdrawal of dialysis. The patients were divided into recovery (RC; n = 12) and non-recovery (N-RC; n = 42) groups. The two groups were compared for variables which might predict RC. They were also assessed for survival. Nine of the RC and 6 of the N-RC patients presented with acute oliguria (p = 0.01). The initial mean arterial pressure was significantly higher in the RC than the N-RC group (178 +/- 17 vs. 160 +/- 27 mm Hg; p = 0.03). Although not statistically significant, more females recovered (8 of 12 vs. 16 of 42; p < 0.1). More patients presenting with serum creatinine concentrations < 1,000 mumol/l (11 mg/dl) recovered (p = 0.09), while the presence of microangiopathic-haemolytic anaemia occurred more frequently in the RC (7 of 10) than in the N-RC (15 of 35) group (p = 0.16)> Age, kidney size, and the presence of hypertensive retinopathy did not distinguish between the two groups. RC patients had a greater long-term survival (Mantel-Cox chi2 = 4.48; p = 0.03). The renal function RC may be related to the type of dialysis provided (intermittent peritoneal dialysis) and to the use of modern potent peripheral vasodilator antihypertensive agents. Potential renal function RC should always be considered in patients being dialyzed for primary malignant hypertension.

Prevalence of micro- and macroalbuminuria and their relationship with other cardiovascular risk factors in essential hypertension.

A cohort of 227 untreated essential hypertensive patients from north-western Italy was studied in order to evaluate the prevalence of micro- and macroalbuminuria and their relationship with other cardiovascular risk factors. Albuminuria was evaluated as the albumin to creatinine ratio (Alb/Cr) in three non-consecutive first morning samples. The prevalence of microalbuminuria and macroalbuminuria was 10% and 2.2%, respectively. Albuminuric patients showed higher blood pressure, serum creatinine, triglycerides and uric acid as well as a greater prevalence of retinopathy. Stepwise multiple regression analysis demonstrated that only a small part of variations in albuminuria was explained by changes in blood pressure. Duration of disease did not seem to influence microalbuminuria. The presence of hypertensive retinopathy was associated with greater albuminuria, longer duration of hypertension, and higher prevalence of major ECG changes, but not with higher blood pressure levels. Microalbuminuria, rather than a consequence of elevated blood pressure levels, seems to be a marker of a syndrome featuring, among other characteristics, essential hypertension. Furthermore, microalbuminuria must be considered as an independent cardiovascular risk factor.