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Hypertension & HYPERTENSIVE RETINOPATHY

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simple explanation about hypertension & hypertensiveretinopathy

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Hypertension & HYPERTENSIVE RETINOPATHY

  1. 1. HYPERTENSION LINTA K P LIMSAR LF Hospital
  2. 2. INTRODUCTION Hypertension is one of the most common worldwide diseases affecting humans • Normal BP : 140/80 mm of hg • Hypertension is the high blood pressure • BP is the force of blood against the artery wall as it flows through them • A patient is said to be hypertensive when his SBP≥140 mm of hg & DBP≥90mm of hg that the patient is not on antihypertensive drugs
  3. 3. CLASSIFICATION Etiological classification Essential HTN (1* HTN) • Idiopathic • BP is regulated by the renal , hormonal , vascular & neurologic systems Secondary HTN • In this class , etiology of the high BP can be identified • Its due to Renal , Endocrine , Neurogenic , Mechanical , Exogenous , & miscellaneous
  4. 4. Based on recommendations of the 7th report of the joint national committee of Prevention , detection , Evaluation & Tx of high BP the classification of BP for adults aged 18 years or older is as follows; • Normal : SBP <120 , DBP <80 mm of hg • Prehypertension : SBP 120-139 , DBP 80-89 • Stage 1 : SBP 140-159 , DBP 90-99 • Stage 2: SBP ≥ 160 , DBP ≥ 100
  5. 5. According to severity Mild ( SBP : 140-160 & DBP : 90-100) Moderate (SBP :160-200 & DBP : 100-120) Severe (SBP : Above 200 & DBP : Above 120) Another classification Border line Labile. Sustained Malignant Accelerated
  6. 6. OTHER CAUSES • Kidney disease • Adrenal gland tumors • Increased salt intake • Tobacco use • Alcohol abuse • Stress • Certain medications etc
  7. 7. SYMPTOMS & SIGNS • Usually asymptomatic (that’s why its called silent killer) • Patient can have following symptoms; • Breathlessness • Headache • Bleeding from nose • Fatigue & sleepiness • Profuse sweating • Blurred vision
  8. 8. COMPLICATIONS • Thickens heart muscle (left ventricular HTN) • Ischemic heart disease • Heart failure • Stroke • Kidney failure • Loss or reduced vision • Trouble with memory • Aneurysm • Metabolic syndrome
  9. 9. TIPS TO CONTROL HTN Eat less salt Exercise Stop smoking & alcohol Healthy diet Reduce weight
  10. 10. Hypertensive retinopathy Hypertensive choroidopathy Hypertensive optic neuropathy
  11. 11. NORMAL FUNDUS
  12. 12. HYPERTENSIVE RETINOPATHY • Retinopathy consists of a spectrum of retinal vascular changes that are pathologically related to transient & persistent micro vascular damage from elevated blood pressure
  13. 13. FUNDUS CHANGES Prolonged systemic hypertension results in retinal vascular effects ;  Vessel narrowing Arterio venous crossings Microaneurysms Hemorrhages Cotton-wool spots Macular star Papilledema
  14. 14. VESSEL NARROWING
  15. 15. • Chronic HTN with significant elevation in diastolic pressure directly related to narrowing of caliber of vessel • Arteriole narrowing is best judged by comparing the caliber of artery with that of adjacent retinal venule • Atherosclerosis & ↑sed DBP – Vessel wall hyperplasia - Fibrosis – Luminal narrowing
  16. 16. ARTERIO VENOUS CROSSINGS
  17. 17. • The retinal arteriole & venule share a common adventitial sheath in the area where they cross each other & artery compress vein (A-V nicking / nipping) • Compression of vein → venule deviation , vein humping • BANKING – Distal : dilation of vein - Proximal : Narrowing of vein
  18. 18. MICROANEURYSMS
  19. 19. • Small round dark red dots on retinal surface • Best detected on FFA • Beginning as dilations in areas in capillary wall where pericytes are absent • Initially they are thin walled & Later endothelial cells proliferate & lay down layers of basement membrane material around themselves • ↑se in number as the degree of retinal involvement • ↑se in no. – capillary occlusion – retinal ischemia
  20. 20. HEMMORRHAGES
  21. 21. • H’ges occurs superficially in the Nerve fibre layer • Streak appearance - FLAME shaped h’ge – macular edema & subsequent vision loss • It’s a result of chronic hypertensive damage to the capillary wall endothelium – extravasation of plasma from lumen into the extracapillary space
  22. 22. COTTON WOOL SPOTS • Chronic HTN + Arteriolar sclerosis - Arteriole occlusion - focal ischemia - formation of soft exudates - CWS MACULAR STAR • Deposition of lipid in the henle’s layer • Yellowish white exudates accumulate in macula in HTR & take an appearance of a star PAPILLEDEMA • Unilateral swelling of the optic nerve head • Due to direct effect on optic nerve or its blood supply • Its an imp sign of malignant HTN
  23. 23. GRADING OF HTR Keith & wegner (1939) have classified HTR changes into 4 grades ; GRADE 1 • Mild generalized arteriolar attenuation GRADE 2 • Marked generalized narrowing • Salus sign GRADE 3 • Grade 2 • Copper wiring • Bonnet sign • Gunn sign • Flame h’ge,CWS,hard exudates GRADE 4 • Grade 3 • Silver wiring • papilloedema
  24. 24. • Salus sign : right angle deflection of veins at A-V crossing • Bonnet sign: banking of veins distal to A-V crossings • Gunn sign : tapering of veins on either side of the crossings
  25. 25. HYPERTENSIVE CHOROIDOPATHY • Its a rare but may occur as the result of accelerated HTN in young adults • Choroidal vascular bed shows impaired circulation & extensive occlusive & ischemic changes
  26. 26. ELSCHING SPOTS -small black spots surrounded by yellow halos -represents focal choroidal infarcts SIEGRIST STREAKS -Linear hyperpigmented streaks oor flecks arranged over choroidal arteries EXUDATIVE RETINAL DETACHMENT -sometimes bilateral , may occur in severe acute HTN
  27. 27. HYPERTENSIVE OPTIC NEUROPATHY • Optic disc edema has been described as an essential manifestation of malignant HTN • Optic disc edema is the initial manifestation of HTON • Our studies indicated that HTON represents a form of AION
  28. 28. CONCLUSION Identify?????????
  29. 29. REFERENCE • The eye in systemic disease : Daniel H Hold • Clinical ophthalmology : jack j kanski & brad bowling • BOS014 • www.ophthobook.com • www.mayoclinic.com
  30. 30. THANK YOU

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