Hypertensive retinopathy revisited: some answers, more questions

Hypertension has profound effects on various parts of the eye. Classically, elevated blood pressure results in a series of retinal microvascular changes called hypertensive retinopathy, comprising of generalized and focal retinal arteriolar narrowing, arteriovenous nicking, retinal hemorrhages, microaneurysms and, in severe cases, optic disc and macular edema. Studies have shown that mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population. Hypertensive retinopathy signs are associated with other indicators of end-organ damage (for example, left ventricular hypertrophy, renal impairment) and may be a risk marker of future clinical events, such as stroke, congestive heart failure and cardiovascular mortality. Furthermore, hypertension is one of the major risk factors for development and progression of diabetic retinopathy, and control of blood pressure has been shown in large clinical trials to prevent visual loss from diabetic retinopathy. In addition, several retinal diseases such as retinal vascular occlusion (artery and vein occlusion), retinal arteriolar emboli, macroaneurysm, ischemic optic neuropathy and age-related macular degeneration may also be related to hypertension; however, there is as yet no evidence that treatment of hypertension prevents vision loss from these conditions. In management of patients with hypertension, physicians should be aware of the full spectrum of the relationship of blood pressure and the eye.

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“…70 Detection of hypertensive retinopathy in subjects with white-coat hypertension may indicate the need for antihypertensive therapy. 71 …”

Section: Genetic Associationsmentioning

confidence: 99%

How does hypertension affect your eyes?

2011

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“…Hypertensive retinopathy is a microvascular injury associated with increased BP and has long been an indicator of atherosclerosis. 84,85 The risk of incident stroke increases by 2-3-folds in patients with retinopathy. Hypertensive retinopathy is also associated with microalbuminuria, renal dysfunction and left ventricular hypertrophy.…”

Section: Albuminuria As An Early Marker Of Strain Vessel Injuriesmentioning

confidence: 99%

Strain vessel hypothesis: a viewpoint for linkage of albuminuria and cerebro-cardiovascular risk

et al. 2009

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Albuminuria is closely associated with stroke and cardiovascular diseases (CVDs) as well as the salt sensitivity of blood pressure (BP). Although albuminuria may reflect generalized endothelial dysfunction, there may be more specific hemodynamic mechanisms underlying these associations. Cerebral hemorrhage and infarction occur most frequently in the area of small perforating arteries that are exposed to high pressure and that have to maintain strong vascular tone in order to provide large pressure gradients from the parent vessels to the capillaries. Analogous to the perforating arteries are the glomerular afferent arterioles of the juxtamedullary nephrons. Hypertensive vascular damage occurs first and more severely in the juxtamedullary glomeruli. Therefore, albuminuria may be an early sign of vascular damages imposed on 'strain vessels' such as perforating arteries and juxtamedullary afferent arterioles. Coronary circulation also occurs under unique hemodynamic conditions, in which the entire epicardial segments are exposed to very high pressure with little flow during systolic phases. From the evolutionary point of view, we speculate that such circulatory systems in the vital organs are mandatory for survival under the danger of hypoperfusion due to difficult access to salt and water as well as high risks of wound injuries. In addition, albuminuria would indicate an impairment of renal medullary circulation, downstream from the juxtamedullary glomeruli, and therefore an impaired pressure natriuresis, which would lead to salt sensitivity of BP. Our 'strain vessel hypothesis' may explain why hypertension and diabetes, unforeseen in the concept of evolution, preferentially affect vital organs such as the brain, heart and kidney.

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“…It was observed in only 0.8% of participants, below prevalence found in other studies. 36 On the other hand, glaucoma was diagnosed in 5.4% of the studied population, higher than the calculated worldwide prevalence (3.54%) for 40-80 years old populations. [37] Other features of the eye that may indicate asymptomatic evolution of glaucoma (intraocular pressure, cup-to-disc ratio, central corneal thickness) were within normality range.…”

Section: Discussionmentioning

confidence: 91%

Ocular Findings in a Brazilian Rural Slave-Descendant Community: Eye Health in Quilombos

Oliveira¹,

Leitão²,

Carvalho³

et al. 2016

Int Arch Med

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Purpose: To report ophthalmological findings from one quilombo remnant population, a Brazilian marginalized rural and slave-descendant community.Methods: Descriptive study of eye health from one of the largest quilombo communities in Brazil, located in Conceição das Crioulas, Pernambuco. Ophthalmic exam including visual acuity, refractive examination, biomicroscopy, fundus examination, tonometry and pachymetry was performed in a convenience sample of 255 residents over 40 years-old, representing approximately one third of the population in this age range.Results: Half of the subjects had never been examined by an ophthalmologist in their lives. Blindness was identified in 6.7% of participants and low vision in 8.6%. Visual impairment was caused mainly by cataract and uncorrected refractive errors. Cataract was found in 27.3% of subjects. Ametropia was documented in 71% of participants and the most prevalent refraction error was hyperopia. Prevalence of glaucoma and age-related macular degeneration were respectively 5.4% and 1.9%. Pterygium was detected in 26.7% of participants. Correcting lenses were prescribed to 57.4% of individuals, 5.5% were referred for surgery, 2.7% to specialized clinics and 1.2% to additional tests. Conclusions:Blindness, cataract and pterygium were highly frequent in quilombo residents, and distribution of other ocular diseases were close to average published rates. Data collected may help planning preventive and promotive actions for eye health of socioeconomic disadvantaged quilombo populations.

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Hypertensive retinopathy revisited: some answers, more questions

Cited by 118 publications

References 111 publications

How does hypertension affect your eyes?

How does hypertension affect your eyes?

Strain vessel hypothesis: a viewpoint for linkage of albuminuria and cerebro-cardiovascular risk

Ocular Findings in a Brazilian Rural Slave-Descendant Community: Eye Health in Quilombos

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