HYPERTENSION

LINTA K P

LIMSAR

LF Hospital

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

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

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

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

OTHER CAUSES

• Kidney disease

• Adrenal gland tumors

• Increased salt intake

• Tobacco use

• Alcohol abuse

• Stress

• Certain medications etc

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

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

TIPS TO CONTROL HTN

Eat less salt

Exercise

Stop smoking & alcohol

Healthy diet

Reduce weight

Hypertensive retinopathy

Hypertensive choroidopathy

Hypertensive optic neuropathy

NORMAL FUNDUS

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

FUNDUS CHANGES

Prolonged systemic hypertension results in

retinal vascular effects ;

Vessel narrowing

Arterio venous crossings

Microaneurysms

Hemorrhages

Cotton-wool spots

Macular star

Papilledema

VESSEL NARROWING

• 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

ARTERIO VENOUS CROSSINGS

• 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

MICROANEURYSMS

• 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

HEMMORRHAGES

• 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

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

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,hardexudates

GRADE 4

• Grade 3

• Silver wiring

• papilloedema

• 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

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

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

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

CONCLUSION

Identify?????????

REFERENCE

• The eye in systemic disease : Daniel H Hold

• Clinical ophthalmology : jack j kanski & brad

bowling

• BOS014

• www.ophthobook.com

• www.mayoclinic.com

THANK YOU