Systemic Hypertension
Hypertensive retinopathy refers to a spectrum of ophthalmic changes secondary to elevated systemic blood pressure. Retinal arterioles can be visualized easily and non-invasively and share similar anatomical and physiological properties with cerebral and c
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Giuseppe Querques, Maria Vittoria Cicinelli, Lea Querques, Ilaria Zucchiatti, Lucia Benatti, Andrea Mazzaferro, Fatemeh Darvizeh, and Francesco Bandello
Abstract
Hypertensive retinopathy refers to a spectrum of ophthalmic changes secondary to elevated systemic blood pressure. Retinal arterioles can be visualized easily and non-invasively and share similar anatomical and physiological properties with cerebral and coronary microcirculation. Therefore, the retina provides a window to study the human circulation in hypertensive patients. Both acute hypertensive peaks and chronically elevated blood pressure may have ocular involvement: arteriovenous nicking is the hallmark of long-standing disease. Retinopathy has been graded in mild, moderate, and severe according to ocular findings and systemic risk. Accurate diagnosis of hypertensive retinopathy, especially that associated with malignant hypertension, is necessary to avoid visual and systemic morbidity and to address prompt treatment. In the United States, an estimated 25% of all adults and 60% of individuals over 60 years suffer from hypertension, corresponding to about 50 million people. Blacks have a higher prevalence than whites, and men are affected more than women until 50 years of age when women have a higher prevalence [1]. High blood pressure is classified into different classes: • Essential hypertension, of unknown etiology and diagnosed when the average blood pressure measures >140 mmHg systolic or >90 mmHg diastolic.
G. Querques (*) • M.V. Cicinelli • L. Querques • I. Zucchiatti • L. Benatti • A. Mazzaferro F. Darvizeh • F. Bandello Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, via Olgettina 60, 20132 Milan, Italy e-mail: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected] © Springer Nature Singapore Pte Ltd. 2018 J. Chhablani et al. (eds.), Retinal and Choroidal Imaging in Systemic Diseases, https://doi.org/10.1007/978-981-10-5461-7_14
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• Secondary hypertension, when caused by medical o iatrogenic condition and can be cured with correction of the underlying disease. • Malignant hypertension: affects 1% of the hypertensive population, occurring when the systolic blood pressure is ≥200 mmHg and the diastolic is ≥130 mmHg. Life-threatening complications are headache, proteinuria, stroke, kidney failure, and encephalopathy. Ocular symptoms include scotoma, diplopia, blurred vision, and photopsias. Hypertension is often underdiagnosed or inadequately treated despite the relative ease of detection [2]. Untreated or inadequately treated hypertension carries significant cardiovascular and renal mortality. In patients with borderline hypertension, the relative risk of cardiovascular disease and end-stage renal disease is nearly double that of patients with optimal blood pressure [3]. Hypertensive retinopathy is nowaday
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