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Hypertension & HYPERTENSIVE RETINOPATHY
- 1. HYPERTENSION LINTA K P LIMSAR LFHospital
- 2. INTRODUCTION Hypertension is oneof 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. 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. Based on recommendationsof 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. 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
- 15. OTHER CAUSES • Kidneydisease • Adrenal gland tumors • Increased salt intake • Tobacco use • Alcohol abuse • Stress • Certain medications etc
- 16. 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
- 17. COMPLICATIONS • Thickens heartmuscle (left ventricular HTN) • Ischemic heart disease • Heart failure • Stroke • Kidney failure • Loss or reduced vision • Trouble with memory • Aneurysm • Metabolic syndrome
- 18. TIPS TO CONTROLHTN Eat less salt Exercise Stop smoking & alcohol Healthy diet Reduce weight
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- 22. HYPERTENSIVE RETINOPATHY • Retinopathyconsists of a spectrum of retinal vascular changes that are pathologically related to transient & persistent micro vascular damage from elevated blood pressure
- 23. FUNDUS CHANGES Prolonged systemichypertension results in retinal vascular effects ; Vessel narrowing Arterio venous crossings Microaneurysms Hemorrhages Cotton-wool spots Macular star Papilledema
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- 25. • Chronic HTNwith 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
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- 27. • The retinalarteriole & 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
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- 29. • Small rounddark 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
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- 31. • H’ges occurssuperficially 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
- 33. 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
- 34. 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
- 35. • 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
- 37. HYPERTENSIVE CHOROIDOPATHY • Its arare but may occur as the result of accelerated HTN in young adults • Choroidal vascular bed shows impaired circulation & extensive occlusive & ischemic changes
- 38. ELSCHING SPOTS -small blackspots 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
- 39. HYPERTENSIVE OPTIC NEUROPATHY • Opticdisc 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
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- 41. REFERENCE • The eyein systemic disease : Daniel H Hold • Clinical ophthalmology : jack j kanski & brad bowling • BOS014 • www.ophthobook.com • www.mayoclinic.com
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