simple explanation about hypertension & hypertensiveretinopathy

1. HYPERTENSION
LINTA K P
LIMSAR
LF Hospital

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. 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 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. 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
• Kidney disease
• 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 heart muscle (left ventricular HTN)
• Ischemic heart disease
• Heart failure
• Stroke
• Kidney failure
• Loss or reduced vision
• Trouble with memory
• Aneurysm
• Metabolic syndrome

18. TIPS TO CONTROL HTN
Eat less salt
Exercise
Stop smoking
& alcohol
Healthy diet
Reduce
weight

20. Hypertensive retinopathy
Hypertensive choroidopathy
Hypertensive optic neuropathy

21. NORMAL FUNDUS

22. 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

23. FUNDUS CHANGES
Prolonged systemic hypertension results in
retinal vascular effects ;
 Vessel narrowing
Arterio venous crossings
Microaneurysms
Hemorrhages
Cotton-wool spots
Macular star
Papilledema

24. VESSEL NARROWING

25. • 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

26. ARTERIO VENOUS CROSSINGS

27. • 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

28. MICROANEURYSMS

29. • 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

30. HEMMORRHAGES

31. • 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

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 a rare 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 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

39. 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

40. CONCLUSION
Identify?????????

41. REFERENCE
• The eye in systemic disease : Daniel H Hold
• Clinical ophthalmology : jack j kanski & brad
bowling
• BOS014
• www.ophthobook.com
• www.mayoclinic.com

42. THANK YOU