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Update on Hypertensive Retinopathy

Update on Hypertensive Retinopathy. Dkt . Muchai Gachago. Introduction. First described in the late 1800s Used to predict risk of stroke, cardiovascular disease, and even mortality Epidemiology HR in 3 % to 14% of nondiabetic adults age ≥40. 1 0 year cumulative incidence is 16 %.

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Update on Hypertensive Retinopathy

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  1. Update on Hypertensive Retinopathy Dkt. MuchaiGachago

  2. Introduction • First described in the late 1800s • Used to predict risk of stroke, cardiovascular disease, and even mortality Epidemiology • HR in 3% to 14% of nondiabetic adults age ≥40. • 10 year cumulative incidence is 16%.

  3. PATHOGENESIS AND PRESENTATION • spectrum of “retinal vascular signs” caused by elevated blood pressure. • Autoregulationof the vasculature → breakdown of autoregulationpathways and atherosclerosis

  4. Signs

  5. Signs

  6. Signs

  7. Signs

  8. Signs

  9. Long-term Consequences • Arteriolosclerosis - irreversible→opacification, compression of venules. • BRB disruption→“exudative” stage • “Malignant” stage → optic disc and macular oedema due to raised intracranial pressure.

  10. Keith–Wagener–Barker Classification -Poor reliability and reproducibility -Grades do not correlate with severity of hypertension -Not sequential in nature • -Grades do not correlate with prognosis, cardiovascular events, and mortality.

  11. Simplified Classification -Good reliability and reproducibility. -Predicted the long-term risk of stroke. -Ease of use -Appropriate stratification of cardiovascular risk disease.

  12. Recent Observations • ↑blood pressure →higher frequency of retinopathy signs • Long-term hypertension → Generalized retinal arteriolar narrowing & AVN. Assoc with ↑BP control in past 10yrs • Focal arteriolar narrowing and retinopathy lesions related only to concurrently measured blood pressure. • Assoc between BP and retinal microvascular signs ↓with age • Smaller retinal arteriolar and larger venularcalibers precede clinical stages of hypertension and predict the risk of hypertension in initially normotensiveindividuals.

  13. RELATIONSHIP WITH TARGET ORGAN DAMAGE Atherosclerosis Risk in Communities (ARIC) study, subjects with HR: • ↑ risk of developing incident stroke • Cognitive decline • Cerebral white matter lesions • Cerebral atrophy • Predicted the long-term risk of stroke • Incident stroke (19.3% vs 4.3%) and incident cerebral infarction (15.5% vs 3.6%)

  14. Kidney and Heart Disease • ↑Chronic kidney disease (CKD) & microalbuminuria • Stroke * 7 • Heart attack * 4 • Coronary artery disease * 3 • Peripheral artery disease * 2

  15. CLINICAL MANAGEMENT

  16. Hypertensive Choroidopathy Elschnig Spots: Focal choroidal infarcts Siegrist Streaks: Fibrinoid necrosis Exudative RD

  17. Complications

  18. Complications

  19. Complications

  20. Further Reading • Retinal Physician, Volume: 10 , Issue: November 2013, page(s): 43 – 54...Review Article Reviewing 96 papers on Hypertension and HR.

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