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Retinal and Choroidal Manifestations of Systemic Hypertension

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Retinal and Choroidal Manifestations of Selected Systemic Diseases

Abstract

Systemic (essential) hypertension is common and has well-described effects on the retinal and choroidal vasculature. Because systemic hypertension is frequently asymptomatic, the presenting signs and symptoms may be visual. Hypertensive retinopathy has been linked to increased vascular morbidity and mortality. Therefore, early detection of ophthalmologic changes may lead to intensified blood pressure management, thus preserving vision and improving general health. In addition, hypertension is associated with several important retinal diseases, including retinal vascular occlusion, diabetic retinopathy, and anterior ischemic optic neuropathy.

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References

  1. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289: 2560–72.

    Article  PubMed  CAS  Google Scholar 

  2. Liebreich R. Ophthalmoskopischer Befund bei Morbus Brightii. Albrecht Von Graefes Arch Ophthalmol. 1859;5:265–8.

    Google Scholar 

  3. Gunn RM. Ophthalmoscopic evidence of (1) arterial changes associated with chronic renal diseases and (2) of increased arterial tension. Trans Ophthalmol Soc UK. 1892;12:124–5.

    Google Scholar 

  4. DellaCroce JT, Vitale AT. Hypertension and the eye. Curr Opin Ophthalmol. 2008;19:493–8.

    Article  PubMed  Google Scholar 

  5. Wong TY, Mitchell P. The eye in hypertension. Lancet. 2007;369:425–35.

    Article  PubMed  Google Scholar 

  6. Keith N, Wagener H, Barker N. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1939;197:332.

    Article  Google Scholar 

  7. Scheie HG. Evaluation of ophthalmoscopic changes of hypertension and arteriolar sclerosis. AMA Arch Ophthalmol. 1953;49:117–38.

    Article  PubMed  CAS  Google Scholar 

  8. Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med. 2004;351:2310–7.

    Article  PubMed  CAS  Google Scholar 

  9. Tso MO, Jampol LM. Pathophysiology of hypertensive retinopathy. Ophthalmology. 1982;89:1132–45.

    PubMed  CAS  Google Scholar 

  10. Hayreh SS. Duke-Elder lecture: systemic arterial blood pressure and the eye. Eye. 1996;10:5–28.

    Article  PubMed  Google Scholar 

  11. Kishi S, Tso MO, Hayreh SS. Fundus lesions in malignant hypertension. II. A pathologic study of experimental hypertensive optic neuropathy. Arch Ophthalmol. 1985;103:1198–206.

    Article  PubMed  CAS  Google Scholar 

  12. Luo BP, Brown GC. Update on the ocular manifestations of systemic arterial hypertension. Curr Opin Ophthalmol. 2004;15:203–10.

    Article  PubMed  Google Scholar 

  13. Umapathi T, Wong SL. Unilateral malignant hypertensive retinopathy. Neurology. 2006;67:690.

    Article  PubMed  CAS  Google Scholar 

  14. Suzuki M, Minamoto A, Yamane K, et al. Malignant hypertensive retinopathy studied with optical coherence tomography. Retina. 2005;25:383–4.

    Article  PubMed  Google Scholar 

  15. Olson JL, Prall FR, Ciardella AP. Bilateral foveal neurosensory detachment in hypertensive retinopathy demonstrated by optical coherence tomography. Eye. 2006;20:1370–1.

    Article  PubMed  CAS  Google Scholar 

  16. Wong TY, Klein R, Couper DJ, et al. Retinal microvascular abnormalities and incident strokes: the Atherosclerosis Risk in Communities Study. Lancet. 2001;358:1134–40.

    Article  PubMed  CAS  Google Scholar 

  17. Wong TY, Klein R, Sharrett AR, et al. Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis Risk in Communities Study. Stroke. 2002;33:1487–92.

    Article  PubMed  Google Scholar 

  18. Wong TY, Klein R, Nieto FJ, et al. Retinal microvascular abnormalities and 10-year cardiovascular mortality: a population-based case–control study. Ophthalmology. 2003;110:933–40.

    Article  PubMed  Google Scholar 

  19. Kishi S, Tso MOM, Hayreh SS. Fundus lesions in malignant hypertension: I. A pathologic study of experimental hypertensive choroidopathy. Arch Ophthalmol. 1985;103:1189–97.

    Article  PubMed  CAS  Google Scholar 

  20. Elschnig A. Die diagnostische und prognostische Bedeutung der Netzhauterkrankungen bei Nephritis. Wien Med Wochenschrift. 1904;54:446.

    Google Scholar 

  21. Ugarte M, Horgan S, Rassam S, Leong T, Kon CH. Hypertensive choroidopathy: recognizing clinically significant end-organ damage. Acta Ophthalmol. 2008;86: 227–8.

    Article  PubMed  Google Scholar 

  22. Yang SS, Fu AD, McDonald RH, et al. Massive spontaneous choroidal hemorrhage. Retina. 2003;23(2): 139–44.

    Article  PubMed  Google Scholar 

  23. National High Blood Pressure Education Working Group. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 suppl):555–76.

    Article  Google Scholar 

  24. Foster BJ, Ali H, Mamber S, Polomeno RC, Mackie AS. Prevalence and severity of hypertensive retinopathy in children. Clin Pedatr (Phila). 2009;48:926–30.

    Article  Google Scholar 

  25. Dimmitt SB, West JN, Eames SM, et al. Usefulness of ophthalmoscopy in mild to moderate hypertension. Lancet. 1989;1:1103–6.

    Article  PubMed  CAS  Google Scholar 

  26. Tramontan L, Grisan E, Ruggeri A. An improved system for the automatic estimation of the arteriolar-to-venular diameter ratio (AVR) in retinal images. Conf Proc IEEE Eng Med Biol Soc. 2008;2008:3550–3.

    PubMed  Google Scholar 

  27. Bock KD. Regression of retinal vascular changes by antihypertensive therapy. Hypertension. 1984;6:III-158–62.

    Article  CAS  Google Scholar 

  28. Wong TY. Fred Hollows lecture: hypertensive retinopathy: a journey from fundoscopy to digital imaging. Clin Exp Ophthalmol. 2006;34:397–400.

    Article  Google Scholar 

  29. Sabbatini M, Tomassoni D, Di Tullio MA, Amenta F. Neuroprotective effect of treatment with calcium antagonists on hypertensive retina. Clin Exp Hypertens. 2002;24:727–40.

    Article  PubMed  CAS  Google Scholar 

  30. Susic D. Hypertension, aging, and atherosclerosis: the endothelial interface. Med Clin North Am. 1997;81: 1238–40.

    Article  Google Scholar 

  31. Morriss DS, Somner J, Donald MJ, et al. The eye at altitude. Adv Exp Med Biol. 2006;588:249–70.

    Article  Google Scholar 

  32. Raja V, Rajagopalan S, Kashab T, Moriarty B. Radiation retinopathy: a mistaken diagnosis of hypertensive retinopathy. Clin Exp Optom. 2007;90: 468–70.

    Article  PubMed  Google Scholar 

  33. Sharp PS, Chaturvedi N, Wormald R, McKeigue PM, Marmot MG, Young SM. Hypertensive retinopathy in Afro-Caribbeans and Europeans: prevalence and risk factor relationships. Hypertension. 1995;25:1322–5.

    Article  PubMed  CAS  Google Scholar 

  34. Wong TY, Klein R, Duncan BB, et al. Racial differences in the prevalence of hypertensive retinopathy. Hypertension. 2003;41:1086–91.

    Article  PubMed  CAS  Google Scholar 

  35. Pontremoli R, Sofia A, Tirotta A, et al. The deletion polymorphism of the angiotensin 1-converting enzyme gene is associated with target organ damage in essential hypertension. J Am Soc Nephrol. 1996;7:2550–8.

    PubMed  CAS  Google Scholar 

  36. Yilmaz MI, Sonmez A, Kilic S, et al. The association of plasma adiponectin levels with hypertensive retinopathy. Eur J Endocrinol. 2005;152:233–40.

    Article  PubMed  CAS  Google Scholar 

  37. Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 1994;118:766–80.

    PubMed  CAS  Google Scholar 

  38. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–13.

    Article  Google Scholar 

  39. Rabb MF, Gagliano DA, Teske MP. Retinal arterial macroaneurysms. Surv Ophthalmol. 1988;33:73–96.

    Article  PubMed  CAS  Google Scholar 

  40. Wilson LA, Warlow CP, Russell RW. Cardiovascular disease in patients with retinal arterial occlusion. Lancet. 1979;1:292–4.

    Article  PubMed  CAS  Google Scholar 

  41. Mitchell P, Wang JJ, Li W, Leeder SR, Smith W. Prevalence of asymptomatic retinal emboli in an Australian urban community. Stroke. 1997;28:63–6.

    Article  PubMed  CAS  Google Scholar 

  42. Hayreh SS, Zimmerman B, McCarthy MJ, Podhajsky P. Systemic diseases associated with various types of retinal vein occlusion. Am J Ophthalmol. 2001;131:61–77.

    Article  PubMed  CAS  Google Scholar 

  43. Age-Related Eye Disease Study Research Group. Risk factors associated with age-related macular degeneration. A case–control study in the Age-Related Eye Disease Study: Age-Related Eye Disease Study report number 3. Ophthalmology. 2000;107:2224–32.

    Article  Google Scholar 

  44. Mitchell P, Lee AJ, Roctchina E, Wang JJ. Open-angle glaucoma and systemic hypertension: the Blue Mountains Eye Study. J Glaucoma. 2004;13:319–26.

    Article  PubMed  Google Scholar 

  45. Park YH, Kim SY, Lee YC. Macular hole formation, spontaneous closure, and reopening in severe hypertensive choroidopathy. Clin Experiment Ophthalmol. 2007;35:586–8.

    Article  PubMed  Google Scholar 

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Correspondence to William F. Mieler M.D. .

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Schwartz, S.G., Schneider, S., Mieler, W.F. (2013). Retinal and Choroidal Manifestations of Systemic Hypertension. In: Arévalo, J. (eds) Retinal and Choroidal Manifestations of Selected Systemic Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3646-1_22

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  • DOI: https://doi.org/10.1007/978-1-4614-3646-1_22

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