Hypertensive retinopathy

Hypertensive retinopathy

Hypertensive retinopathy with AV nicking and mild vascular tortuosity
Classification and external resources
Specialty ophthalmology
ICD-10 H35.0
ICD-9-CM 362.11
MedlinePlus 000999
MeSH D058437

Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure (i.e. hypertension).

Pathophysiology

The changes in hypertensive retinopathy result from damage and adaptive changes in the arterial and arteriolar circulation in response to the high blood pressure. ..

Symptoms

Most patients with hypertensive retinopathy present no visual symptoms. However, some may report decreased vision or headaches.

Signs

Signs of damage to the retina caused by hypertension include:

Mild signs of hypertensive retinopathy can be seen quite frequently in normal people (3–14% of adult individuals aged ≥40 years), even without hypertension.[1]

Keith Wagener Barker (KWB) Grades

Grade 1
Arteriolar constriction/attenuation/sclerosis -`silver wiring` and vascular tortuosities
Grade 2
As grade 1 + Irregularly located, tight constrictions - Known as `AV nicking` or `AV nipping`
Grade 3
As grade 2 + Retinal edema, cotton wool spots and flame-hemorrhages
Grade 4
As grade 3 + optic disc edema + macular star

There is an association between the grade of retinopathy and mortality. In a classic study in 1939 Keith and colleagues[2] described the prognosis of people with differing severity of retinopathy. They showed 70% of those with grade 1 retinopathy were alive after 3 years whereas only 6% of those with grade 4 survived.The most widely used modern classification system bears their name.[1] The role of retinopathy grading in risk stratification is debated, but it has been proposed that individuals with signs of hypertensive retinopathy signs, especially retinal hemorrhages, microaneurysms and cotton-wool spots, should be assessed carefully.[1]

Differential Diagnoses

Several other diseases can result in retinopathy that can be confused with hypertensive retinopathy. These include diabetic retinopathy, retinopathy due to autoimmune disease, anemia, radiation retinopathy, central retinal vein occlusion.

Treatment and management

A major aim of treatment is to prevent, limit, or reverse target organ damage by lowering the patient's high blood pressure and reduce the risk of cardiovascular disease and death. Anti-hypertensive drug treatment may be required to control the high blood pressure.

See also

References

  1. 1 2 3 Wong TY, Mcintosh R (2005). "Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality". British Medical Bulletin. 73-74: 57–70. doi:10.1093/bmb/ldh050. PMID 16148191.
  2. ↑ Keith NM, Wagener HP, Barker NW (1939) Some different types of essential hypertension: their course and prognosis. Am J Med Sci, 197, 332–43.

Further reading

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