Fucoidan modulates SIRT1 and NLRP3 to alleviate hypertensive retinopathy: in vivo and in vitro insights.

BACKGROUND: Hypertension influences the inflammatory pathological changes in the retina. The function of the inflammasomes is significant. To see if Sirtuin 1 (SIRT1) regulates angiotensin II (Ang II)-induced hypertensive retinopathy and inflammation by modulating NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome activation and the potential protective effects of fucoidan (FO) in mouse retinal vascular endothelial cells (mRECs) and mice retina. METHODS: The diagnosis of hypertensive retinopathy was made after three weeks of Ang II infusion (3000 ng/kg/min). One day prior to the commencement of Ang II infusion, the mice were treatment with NLRP3 inhibitor MCC950 (10 mg/kg/day, intraperitoneal injections) or FO (300 mg/kg/day, oral gavage). A blood pressure was recorded. Hematoxylin and eosin (H&E) staining was used to conduct pathological alterations, dihydroethidium bromide (DHE) was utilized to assess oxidative stress damage in the retina, and fluorescence angiography was used to identify vascular disorders in the eye. Using immunohistochemical labeling, NLRP3 expression was found. Reactive protein and mRNA expression levels in mouse retina and cells were assessed using Western blot and real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS: NLRP3 inflammasome activation and SIRT1 decrease were brought about by Ang II infusion. Retinopathy and dysfunction were lessened by MCC950 target-induced NLRP3 inflammasome activation, while overexpression of SIRT1 had the opposite impact on NLRP3 inflammasome activation, indicating that SIRT1 functions as an upstream regulator of NLRP3 activity. FO may improve SIRT1 expression and decrease NLRP3 activation in retinopathy and dysfunction brought on by Ang II, and the effects were consistent across both in vivo and in vitro models. CONCLUSIONS: SIRT1 adversely regulates the NLRP3 inflammasome pathway, which in turn increases Ang II-induced inflammation and hypertensive retinopathy. FO may mitigate Ang II-induced retinopathy and dysfunction via modulating the expression of SIRT1/NLRP3. This implies practical approaches to the management of hypertensive retinopathy.

Detección de la progresión de la retinopatía externa oculta zonal aguda (AZOOR) con angiografía por tomografía de coherencia óptica: a propósito de un caso / Detecting progression of acute zonal occult outer retinopathy (AZOOR) with optical coherence tomography angiography: A case report

Caso clínico Mujer de 48años con escotomas superotemporales persistentes y fotopsias de 2meses de evolución y zonas despigmentadas en retina de ambos ojos con patrón trizonal en imagen multimodal. La resonancia magnética cerebral, la tomografía por emisión de positrones, los anticuerpos antirretinianos y los marcadores inmunológicos, infecciosos y tumorales fueron negativos, por lo que se diagnosticó retinopatía externa oculta zonal aguda. La paciente fue tratada con adalimumab. Sin embargo, 19meses después los síntomas aumentaron y se detectó progresión en la angiografía por tomografía de coherencia óptica, así como también en la prueba de campo visual Humphrey y el electrorretinograma, por lo que se agregó micofenolato de mofetilo, mostrando mejoría y estabilización de la enfermedad durante un seguimiento de 4años. Discusión La angiografía por tomografía de coherencia óptica puede ser una herramienta potencial para monitorizar la progresión y la respuesta al tratamiento además de otras modalidades de imagen en la retinopatía externa oculta zonal aguda, y la combinación de adalimumab y micofenolato puede ser útil en la enfermedad recurrente (AU)

Clinical case A 48-year-old woman with persistent superotemporal scotomas and photopsias for 2months, and depigmented zones in the retina of both eyes with a trizonal pattern on multimodal imaging. Brain magnetic resonance imaging, positron emission tomography, antiretinal antibodies and immunological, infectious and tumor markers tests were negative, thus acute zonal occult outer retinopathy was diagnosed. Patient was treated with adalimumab. Nevertheless, 19months later symptoms increased, and progression was detected on optic coherence tomography angiography, as well as in Humphrey visual field test and electroretinogram, thus, mycophenolate mofetil was added showing improvement and stabilization of the disease in a 4-year follow-up. Discussion Optic coherence tomography angiography may be a potential tool to monitor progression and response to treatment in addition to other imaging modalities in acute zonal occult outer retinopathy, and the combination of adalimumab and mycophenolate may be useful in recurrent disease (AU)

Hypertensive retinopathy and Purtscher-like retinopathy in a child with complement 3 glomerulopathy.

We report the case of a 15-year-old boy with hypertensive retinopathy and Purtscher-like retinopathy eventually diagnosed with complement 3 glomerulopathy (C3G). The patient presented with bilateral severe painless visual loss and posterior pole cotton wool spots, optic disk and macular edema, and macular star-shaped hard exudate depositions, arterial narrowing, and venous tortuosity, indicative of hypertensive retinopathy (with an initial blood pressure of 210/130 mm Hg) and Purtscher-like retinopathy. He was subsequently diagnosed with C3G based on results of a kidney biopsy. There was a mild visual improvement on follow-up examination, and optic disk swelling and subretinal fluid and cotton wool spots resolved.

Computer-aided diagnostic system for hypertensive retinopathy: A review.

Hypertensive Retinopathy (HR) is a retinal disease caused by elevated blood pressure for a prolonged period. There are no obvious signs in the early stages of high blood pressure, but it affects various body parts over time, including the eyes. HR is a biomarker for several illnesses, including retinal diseases, atherosclerosis, strokes, kidney disease, and cardiovascular risks. Early microcirculation abnormalities in chronic diseases can be diagnosed through retinal examination prior to the onset of major clinical consequences. Computer-aided diagnosis (CAD) plays a vital role in the early identification of HR with improved diagnostic accuracy, which is time-efficient and demands fewer resources. Recently, numerous studies have been reported on the automatic identification of HR. This paper provides a comprehensive review of the automated tasks of Artery-Vein (A/V) classification, Arteriovenous ratio (AVR) computation, HR detection (Binary classification), and HR severity grading. The review is conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The paper discusses the clinical features of HR, the availability of datasets, existing methods used for A/V classification, AVR computation, HR detection, and severity grading, and performance evaluation metrics. The reviewed articles are summarized with classifiers details, adoption of different kinds of methodologies, performance comparisons, datasets details, their pros and cons, and computational platform. For each task, a summary and critical in-depth analysis are provided, as well as common research issues and challenges in the existing studies. Finally, the paper proposes future research directions to overcome challenges associated with data set availability, HR detection, and severity grading.

Retinopatia hipertensiva - relação com o tempo de diagnóstico da hipertensão arterial sistêmica / Hypertensive retinopathy - relation with time of diagnosis of hypertension / Retinopatía hipertensiva - relación con el tiempo de diagnóstico de hipertensión arterial sistémica

Introdução: Hipertensão arterial sistêmica é uma condição em que a pressão do sangue contra as paredes das artérias é muito elevada. O olho, diretamente envolvido no aumento da resistência vascular periférica, é orgão-alvo quando a retinopatia hipertensiva se faz presente. O controle da hipertensão arterial sistêmica desempenha papel fundamental na evolução da retinopatia hipertensiva, considerando o tempo de duração e a idade dos pacientes. Fundoscopia é o exame mais importante para visualizar esses pequenos vasos, sendo possível detectar alterações e classificar a hipertensão arterial sistêmica para uma melhor conduta terapêutica. As alterações vasculares retinianas visualizadas no fundo do olho são classificadas na hipertensão arterial sistêmica em arterioescleróticas e hipertensivas. Objetivo: Identificar os principais fatores relacionados à retinopatia hipertensiva e a relação com o tempo de diagnóstico de hipertensão arterial sistêmica. Método: Estudo transversal, observacional e descritivo. Fundoscopia e Retinografia foram realizados em pacientes do ambulatório de oftalmologia de um hospital-escola no interior paulista, com diagnóstico de hipertensão arterial sistêmica, para avaliar o grau de comprometimento vascular retiniano. Resultados: Foram examinados 236 olhos de 118 pacientes, a maioria do sexo feminino (58,5%), com idade média de 61 anos. Questionados sobre o controle da sua hipertensão arterial sistêmica, as respostas obtidas foram: 48 pacientes (40,7%) souberam responder que sua pressão era controlada com medicação; 60 (50,9%) afirmaram descontrole da pressão sistêmica e 10 (8,4%) não souberam responder. Dos 103 pacientes (88%) que apresentaram alterações na Fundoscopia, 70% apresentaram alterações relacionadas a arteriosclerose e 76 (64%) relacionados à retinopatia hipertensiva. Dos pacientes com arteriosclerose, 74,7% apresentaram alteração no cruzamento arteriovenoso, enquanto os pacientes com retinopatia hipertensiva 51,3% apresentaram vasoconstrição arteriolar espástica. A abordagem terapêutica da HAS é baseada na tentativa de controle dos valores pressóricos e a adesão ao tratamento é um fator fundamental para o manejo de condições e a prevenção de complicações decorrentes delas. Conclusão: Os fatores diagnósticos relacionados à retinopatia hipertensiva foram: o tempo diagnóstico, as alterações vasculares de arterioloesclerose e o descontrole pressórico. As alterações na retinografia servem para auxiliar na gravidade de hipertensão arterial sistêmica bem como alertar e estimular à ter um melhor controle de PA. O envolvimento de toda a equipe de saúde também é necessário para uma visão multidisciplinar do problema, já que a adesão ao tratamento é importante no controle da hipertensão arterial sistêmica

Introduction: Systemic arterial hypertension is a condition in which blood pressure against the walls of the arteries is very high. The eye, directly involved in increasing peripheral vascular resistance, is the target organ when hypertensive retinopathy is present. The control of systemic arterial hypertension plays a fundamental role in the evolution of hypertensive retinopathy, considering the duration and age of the patients. Fundoscopy is the most important exam to visualize these small vessels, making it possible to detect changes and classify systemic arterial hypertension for better therapeutic management. Retinal vascular changes seen in the fundus of the eye are classified in systemic arterial hypertension into arteriosclerotic and hypertensive. Objective: To identify the main factors related to hypertensive retinopathy and the relationship with the time of diagnosis of systemic arterial hypertension. Method: Cross-sectional, observational and descriptive study. Fundoscopy and retinography were performed on patients at the ophthalmology outpatient clinic of a teaching hospital in the interior of São Paulo, diagnosed with systemic arterial hypertension, to assess the degree of retinal vascular compromise. Results: 236 eyes of 118 patients were examined, the majority of them female (58.5%), with a mean age of 61 years. When asked about the control of their systemic arterial hypertension, the answers obtained were: 48 patients (40.7%) were able to answer that their pressure was controlled with medication; 60 (50.9%) stated that they had uncontrolled systemic pressure and 10 (8.4%) were unable to answer. Of the 103 patients (88%) who presented changes on Fundoscopy, 70% presented changes related to arteriosclerosis and 76 (64%) related to hypertensive retinopathy. Of the patients with arteriosclerosis, 74.7% presented changes in arteriovenous crossing, while 51.3% of patients with hypertensive retinopathy presented spastic arteriolar vasoconstriction. The therapeutic approach to SAH is based on trying to control blood pressure values and adherence to treatment is a fundamental factor in managing conditions and preventing complications resulting from them. Conclusion: The diagnostic factors related to hypertensive retinopathy were: time of diagnosis, vascular alterations of arteriolosclerosis and lack of blood pressure control. Changes in retinography serve to help with the severity of systemic arterial hypertension as well as alert and encourage better BP control. The involvement of the entire healthcare team is also necessary for a multidisciplinary view of the problem, as adherence to treatment is important in controlling systemic arterial hypertension

Introducción: La hipertensión arterial sistémica es una condición en la que la presión arterial contra las paredes de las arterias es muy alta. El ojo, directamente implicado en el aumento de la resistencia vascular periférica, es el órgano diana cuando hay retinopatía hipertensiva. El control de la hipertensión arterial sistémica juega un papel fundamental en la evolución de la retinopatía hipertensiva, considerando la duración y edad de los pacientes. La fundoscopia es el examen más importante para visualizar estos pequeños vasos, permitiendo detectar cambios y clasificar la hipertensión arterial sistémica para un mejor manejo terapéutico. Los cambios vasculares retinianos observados en el fondo del ojo se clasifican en la hipertensión arterial sistémica en arteriosclerótica e hipertensiva. Objetivo: Identificar los principales factores relacionados con la retinopatía hipertensiva y la relación con el momento del diagnóstico de la hipertensión arterial sistémica. Método: Estudio transversal, observacional y descriptivo. Se realizaron fundoscopia y retinografía a pacientes del ambulatorio de oftalmología de un hospital universitario del interior de São Paulo, diagnosticados con hipertensión arterial sistémica, para evaluar el grado de compromiso vascular retiniano. Resultados: Se examinaron 236 ojos de 118 pacientes, la mayoría del sexo femenino (58,5%), con una edad media de 61 años. Al preguntarles sobre el control de su hipertensión arterial sistémica, las respuestas obtenidas fueron: 48 pacientes (40,7%) pudieron responder que su presión estaba controlada con medicamentos; 60 (50,9%) afirmaron tener presión sistémica descontrolada y 10 (8,4%) no supieron responder. De los 103 pacientes (88%) que presentaron cambios en la fundoscopia, el 70% presentó cambios relacionados con arteriosclerosis y 76 (64%) relacionados con retinopatía hipertensiva. De los pacientes con arteriosclerosis, el 74,7% presentó cambios en el cruce arteriovenoso, mientras que el 51,3% de los pacientes con retinopatía hipertensiva presentaron vasoconstricción arteriolar espástica. El abordaje terapéutico de la HAS se basa en intentar controlar los valores de presión arterial y la adherencia al tratamiento es un factor fundamental para el manejo de las afecciones y la prevención de complicaciones derivadas de las mismas. Conclusión: Los factores diagnósticos relacionados con la retinopatía hipertensiva fueron: momento del diagnóstico, alteraciones vasculares de la arteriolosclerosis y falta de control de la presión arterial. Los cambios en la retinografía sirven para ayudar con la gravedad de la hipertensión arterial sistémica, así como para alertar y fomentar un mejor control de la PA. También es necesaria la implicación de todo el equipo sanitario para una visión multidisciplinar del problema, ya que la adherencia al tratamiento es importante en el control de la hipertensión arterial sistémica

Risk of retinopathy in women with pregnancy-induced hypertension: a nationwide population-based cohort study of 9-year follow-up after delivery.

BACKGROUND: The retina is potentially associated with several physiological, hormonal, and metabolic changes during pregnancy. The few available epidemiologic studies of ocular changes in pregnancy have mainly concerned retinopathies. Pregnancy-induced hypertension, which leads to ocular manifestations including blurred vision, photopsia, scotoma, and diplopia, might induce reactive changes in the retinal vessels. Although several studies have suggested the existence of pregnancy-induced hypertension-related retinal ocular disease, there are few large cohort studies on this topic. OBJECTIVE: This study aimed to investigate the risk of major retinal diseases including central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, and hypertensive retinopathy in the long-term postpartum stage according to the presence of previous pregnancy-induced hypertension in a large cohort based on the Korean National Health Insurance Database. STUDY DESIGN: On the basis of Korean health data, 909,520 patients who delivered from 2012 to 2013 were analyzed. Among them, patients who had previous ocular diseases or hypertension and multiple births were excluded. Finally, 858,057 mothers were assessed for central serous chorioretinopathy (ICD-10: H35.70), diabetic retinopathy (ICD-10: H36.0, E10.31, E10.32, E11.31, E11.32, E12.31, E13.31, E13.32, E14.31, E14.32), retinal vein occlusion (ICD-10: H34.8), retinal artery occlusion (ICD-10: H34.2), and hypertensive retinopathy (ICD-10: H35.02) for 9 years after delivery. Enrolled patients were divided into 2 groups: 10,808 patients with and 847,249 without pregnancy-induced hypertension. The primary outcomes were the incidence of central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, and hypertensive retinopathy 9 years after delivery. Clinical variables were age, parity, cesarean delivery, gestational diabetes mellitus, and postpartum hemorrhage. In addition, pregestational diabetes mellitus, kidney diseases, cerebrovascular diseases, and cardiovascular diseases were adjusted. RESULTS: Postpartum retinal disease during the 9 years after delivery and total retinal diseases showed higher rates in patients with pregnancy-induced hypertension. In detail, the rates of central serous chorioretinopathy (0.3% vs 0.1%), diabetic retinopathy (1.79% vs 0.5%), retinal vein occlusion (0.19% vs 0.1%), and hypertensive retinopathy (0.62% vs 0.05%) were higher than those found in patients without pregnancy-induced hypertension. After adjusting for confounding factors, pregnancy-induced hypertension was associated with development of postpartum retinopathy, with a >2-fold increase (hazard ratio, 2.845; 95% confidence interval, 2.54-3.188). Furthermore, pregnancy-induced hypertension affected the development of central serous chorioretinopathy (hazard ratio, 3.681; 95% confidence interval, 2.667-5.082), diabetic retinopathy (hazard ratio, 2.326; 95% confidence interval, 2.013-2.688), retinal vein occlusion (hazard ratio, 2.241; 95% confidence interval, 1.491-3.368), and hypertensive retinopathy (hazard ratio, 11.392; 95% confidence interval, 8.771-14.796) after delivery. CONCLUSION: A history of pregnancy-induced hypertension increases the risk of central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, and hypertensive retinopathy according to 9-year long-term ophthalmologic follow-up.

Effect of blood pressure variability on hypertensive retinopathy.

PURPOSE: This study intends to investigate the correlation between blood pressure variability (BPV) levels and the use of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to measure retinal microvasculature in hypertensive patients. METHODS: All individuals in the study had 24-hour ambulatory blood pressure monitoring and bilateral OCT and OCTA exams, and only data from the right eye were analyzed statistically. RESULTS: The study included 170 individuals, with 60 in the control group. The experimental group was separated into two groups based on the average real variability (ARV) median, with 55 in the low ARV group and 55 in the high ARV group. The mean thicknesses of the Retinal Nerve Fiber Layer (RNFL), internal limiting membrane-retinal pigment epithelial cell layer (ILM-RPE), vessel density (VD), and perfusion density (PD) in the high-ARV group were substantially lower in the low-ARV and control groups (p＜0.05). Multiple linear regression analysis revealed that disease duration, age, and 24 h diastolic standard deviation all affected RNFL mean thickness (p＜0.05). VD and PD were influenced by disease duration, systolic-ARV, daytime systolic blood pressure, intraocular pressure(IOP), and best-corrected visual acuity (BCVA) (p＜0.05). And the change in VD was connected to best-corrected visual acuity. CONCLUSION: Hypertensive retinopathy is related to BPV. In clinical practice, we can assess the degree of BPV and retinopathy in hypertensive patients to track the progression of hypertension-mediated organ damage (HMOD). Correction of BPV may help treat or postpone the progression of HOMD.

Alteraciones retinianas detectadas por screening con cámara retinal no midriática y derivación a oftalmología en una población de alto riesgo cardiovascular / Retinal alterations detected by non-mydriatic retinal camera screening and referral to ophthalmology in a population with high cardiovascular risk

Objetivo Describir las principales alteraciones retinianas detectadas por screening con cámara retinal no midriática y evaluar los factores relacionados con la derivación a oftalmología en una población de alto riesgo cardiovascular en Palmira, Colombia. Materiales y métodos Estudio observacional de tipo transversal, con 11.983 registros fotográficos de pacientes con hipertensión y diabetes mellitus del programa de enfermedades crónicas de Gesencro S.A.S. entre 2018 y 2020. Se evaluaron con regresión logística los factores de riesgo relacionados con la derivación a oftalmología y se obtuvieron los odds ratios (OR) crudos y ajustados. Resultados Se analizaron 11.880 registros; la edad media fue de 67,7±12años, y el 69,5% fueron mujeres. Entre las alteraciones retinianas se encontraron pacientes con retinopatía diabética clasificada como más que leve (10%) y gradoI de retinopatía hipertensiva (54,9% ojo derecho, 51,9% ojo izquierdo). También se identificó edema macular (15%). Solo 2.069 (17,4%) pacientes requirieron derivación a oftalmología; el 81,3% requirieron control a 1año y el 1,3% a los 6meses. En el análisis multivariado los factores de riesgo que se relacionaron con la probabilidad para ser derivados fueron: el género masculino, la edad mayor o igual a 60años, la hemoglobina glucosilada (HbA1c) fuera de metas, la enfermedad renal crónica avanzada y la razón microalbúmina-creatinina moderada a severamente elevada. Conclusión Este estudio permitió determinar la importancia que tiene el screening con cámara retinal no midriática en pacientes de alto riesgo cardiovascular para detectar alteraciones retinianas y evaluar factores de riesgo asociados con derivación a oftalmología. El documentar tempranamente el compromiso ocular en estos pacientes podría prevenir y evitar la discapacidad visual y la ceguera (AU)

Objective To describe the main retinal alterations detected by non-mydriatic retinal camera screening and to evaluate factors related to referral to ophthalmology in a population at high cardiovascular risk in Palmira, Colombia. Materials and methods Cross-sectional observational study, which included 11,983 photographic imaging records of patients with hypertension and diabetes mellitus from Gesencro's S.A.S. comprehensive chronic disease care program between 2018 and 2020. Risk factors associated to referral to ophthalmology were evaluated with logistic regression, and crude and adjusted ORs (odds ratios) were obtained. Results A total of 11,880 records were analyzed; 67.7±12years old, and 69.5% were women. Among the retinal alterations were patients with diabetic retinopathy classified as more than mild in 10% and gradeI hypertensive retinopathy in 54.9% right eye, 51.9% left eye. Macular edema was also identified. Only 2069 patients (17.4%) required referral to ophthalmology, and for imaging control 82.6%. In the multivariate analysis, the risk factors associated with the probability of being referred were male gender, age 60years and older, glycosylated hemoglobin out-of-target, advanced chronic kidney disease and the microalbumin-to-creatinine ratio moderate to severely elevated. Conclusion This study makes it possible to determine the importance of screening with a non-mydriatic retinal camera in patients at high cardiovascular risk to detect retinal abnormalities and assess risk factors associated with referral to ophthalmology. Early documentation of ocular compromise in these patients could prevent and avoid visual impairment and blindness (AU)

A Rare Case of Blindness Caused by Syphilis with Malignant Hypertensive Nephropathy.

The number of patients with syphilis has been rapidly increasing. Without treatment, syphilis can damage various organs and become life-threatening. We herein report a 29-year-old woman diagnosed with neurosyphilis, acute hydrocephalus, syphilitic uveitis combined with hypertensive retinopathy, and malignant hypertensive nephropathy. To our knowledge, this is the first report of syphilis complicated with malignant hypertensive nephropathy proven by a renal biopsy. Neurosyphilis was successfully treated with intravenous penicillin G, and severe hypertension subsequently resolved. However, delayed medical examinations and complications of syphilitic uveitis and hypertensive retinopathy resulted in irreversible visual loss. To prevent irreversible organ damage, early treatment is essential.

Correlation between hypertensive retinopathy and fetal outcomes in patients with preeclampsia in a tertiary care hospital: A prospective cohort study.

Purpose: To study the effect of increasing grades of hypertensive retinopathy (HTR) on neonatal outcomes among preeclamptic women and assess the various maternal risk factors for HTR. Methods: A prospective cohort study was conducted on 258 preeclamptic women. The systolic and diastolic blood pressure (SBP and DBP), liver, and renal function parameters were collected besides basic demographic details. Dilated fundus examination with the Keith-Wagner-Barker classification was used to grade HTR. Following delivery, neonatal outcomes were evaluated. Results: Of the 258 preeclamptic women recruited, 53.1% had preeclampsia (PE), and 46.9% had severe preeclampsia. With increasing grades of HTR, a significant association with low birth weight (LBW) (p = 0.012) and preterm gestational age (p = 0.002) was noted but not with the Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score (p = 0.062). Also, it did not increase the risk of retinopathy of prematurity (ROP), with most babies, even those born to mothers with high grades of HTR, showing no evidence of ROP (p = 0.025). Among the maternal factors, increasing age (p = 0.016), SBP (p < 0.001), DBP (p < 0.001), serum creatinine (p = 0.035), alanine aminotransferase (p = 0.008), lower hemoglobin (Hb) (p = 0.009), lower platelet (p < 0.001), and severe PE (p < 0.001) have been found to significantly affect the grade of HTR. Conclusion: Higher grades of HTR in the preeclamptic mother are associated with preterm delivery and LBW of the neonates but neither affect the APGAR score nor pose the risk of developing ROP.

Risk Stratification on Systemic Target Organ Involvement Associated with Hypertensive Retinopathy.

BACKGROUND: Hypertensive retinopathy is a common complication among people with hypertension. The current study assessed the risk stratification on systemic target organ involvement of people with hypertensive retinopathy. METHODS: In a hospital- based cross-sectional study conducted at a tertiary referral eye institute in Nepal, we included consecutive people ≥ 31 years with essential hypertension. Details of histories and systemic target organ involvements were documented. People with un-gradable retinal findings of hypertensive retinopathy and prior retinal surgery were excluded. All participants underwent comprehensive eye examination, including dilated fundus examination. Hypertensive retinopathy was classified by Modified Scheie classification. Multivariate analysis was performed to identify the risks for hypertensive retinopathy and target organ involvement. RESULTS: The study recruited 312 subjects. The mean age was 63.68 ± 12.63 years. The mean duration of hypertension was 7.0 ± 6.5 years. Hypertensive retinopathy was detected in 83.7% (n=261) people and 63.5% (n= 198) had grade 1 hypertensive retinopathy. Target organ involvement was detected in 20.5% (n =64) people. These included cardiac (12.5%; n=39), central nervous (5.1%; n= 16), and renal (4.5%; n=14) systems. In multivariate analysis, concurrent hyperlipidaemia was significantly associated with hypertensive retinopathy and target organ involvement. Target organ involvement increased with the severity of hypertensive retinopathy. CONCLUSIONS: Over four-fifths of people with hypertension had hypertensive retinopathy and one-fifth had other systemic target organ involvements. Severity of hypertensive retinopathy and concurrent hyperlipidaemia were associated with target organ involvement. Hypertensive retinopathy can be considered for risk stratification to other target organ involvement in a clinical setting.

El fondo de ojo, una ventana a la microvasculatura del paciente hipertenso / The fundus, a window to microvasculature in hypertensive patients

Introducción: La hipertensión arterial constituye una de las enfermedades más frecuentes en la población general. En la actualidad llega a una prevalencia global del 30 al 45 %. La microcirculación retiniana puede considerarse como una representación anatómica de las características fisiológicas y funcionales de la circulación coronaria y cerebral. Objetivos: Profundizar en la relación existente entre los niveles de presión arterial y el daño del órgano diana, específicamente a través del fondo de ojo, así como de las posibles complicaciones oftalmológicas derivadas de la hipertensión arterial, y la comparación de algunas de las clasificaciones existentes sobre los cambios oftalmológicos que esta provoca. Métodos: Se emplearon los métodos de análisis-síntesis y análisis bibliográfico y documental. Los motores de búsqueda utilizados fueron: Google y Google Académico, y las bases de datos Hinari, SciELO Cuba, Pubmed, entre otras. Conclusiones: La retinopatía hipertensiva es una de las complicaciones adversas de la hipertensión arterial aguda o crónica. Por su parte, las oclusiones venosas y la formación de macroaneurismas, constituyen otras de gran envergadura. Mientras más eficaz sea el diagnóstico y seguimiento de los pacientes hipertensos, menos recursos se necesitarán para su tratamiento, y se evitarán así las complicaciones de otros órganos diana como el cerebro y el riñón, lo que provocaría en los pacientes una mayor discapacidad.

Introduction: arterial hypertension is one the most frequent diseases in general population. Nowadays, it reaches a global prevalence of 30 to 45 %. Retinal microcirculation can be considered as an anatomical representation of the physiological and functional characteristics of the coronary and cerebral circulation. Objectives: to delve into the relationship between blood pressure levels and target organ damage, specifically through the fundus, as well as the possible ophthalmological complications derived from arterial hypertension, and the comparison of some of the existing classifications on the ophthalmological changes that it causes. Methods: analysis - synthesis and bibliographic- documentary analyses were the used methods. Google and Google Scholar as well as Hinari, SciELO Cuba, Pubmed and others databases were the search engines. Conclusions: hypertensive retinopathy is one of the adverse complications of acute or chronic arterial hypertension. On the other hand, venous occlusions and the formation of macroaneurysms constitute other serious ones to consider. The more effective the diagnosis and follow-up of hypertensive patients, the fewer resources will be needed for their treatment, thus avoiding complications in other target organs such as the brain and kidney, which would cause greater disability in patients.

Positive correlation between hypertensive retinopathy and albuminuria in hypertensive adults.

PURPOSE: We investigated the association between albuminuria and hypertensive retinopathy (HR) in hypertensive adults. METHODS: This was a cross-sectional subgroup analysis of data from the China Stroke Primary Prevention Trial. We enrolled 2,964 hypertensive adults in this study. Keith-Wagener-Barker stages was used to assess HR. The urinary albumin to creatinine ratio (UACR) was calculated to evaluate albuminuria. RESULTS: HR was found in 76.6% (n = 2, 271) of the participants, albuminuria was found in 11.1% (n = 330). The UACR levels were significantly higher in subjects with HR than in those without HR (grade 1, ß = 1.42, 95% confidence intervals [CI]: -0.12, 2.95, p = 0.070; grade 2, ß = 2.62, 95% CI: 0.56, 4.67, p = 0.013; grade 3, ß = 5.17, 95% CI: 1.13, 9.20, p = 0.012). In the subgroup analyses, the association between HR and UACR was stronger in current smokers (p for interaction = 0.014). The correlation between HR grades 1 and 2 and UACR was stronger in subjects with higher triglyceride levels (≥ 1.7 mmol/L), but for grade 3 HR, this correlation was stronger in subjects with lower triglycerides levels (< 1.7 mmol/L, p for interaction = 0.023). The odds of albuminuria were significantly higher in subjects with HR than in those without HR (grade 1, odds ratio [OR] = 1.57, 95% CI: 1.08, 2.29, p = 0.019; grade 2, OR = 2.02, 95% CI: 1.28, 3.18, p = 0.002; grade 3, OR = 2.12, 95% CI: 0.99, 4.55, p = 0.053). In the subgroup analyses, the association between HR grades 1 and 2 and albuminuria was stronger in subjects with higher triglycerides levels (≥ 1.7 mmol/L), but for grade 3 HR, this correlation was stronger in subjects with lower triglyceride levels (< 1.7 mmol/L, p for interaction = 0.014). CONCLUSION: HR was positively correlated with albuminuria in hypertensive Chinese adults. This correlation was more remarkable when the population was stratified by triglycerides levels and smoking status. HR can be used as an indicator of early renal injury.