Hypertensive Retinal Vascular Changes: Relationship to Left Ventricular Hypertrophy and Arteriolar Changes Before and After Treatment

Abstract

Eye-ground-photos were taken in twenty-eight previously untreated men with mild to moderate essential hypertension. The same eye was evaluated before and after 26 weeks of double-blind treatment with Enalapril or Hydrochlorothiazide. The vascular changes were assessed by using a more elaborate and refined grading than the Keith-Wagener-Barker scale. All photos were examined by the same observer without knowledge of blood pressure, type of treatment or the order in which the photos had been taken. There were significant positive correlations between the vascular alterations in the retina in the untreated state and left ventricular wall thickness (echocardiography), minimal vascular resistance in the calf (plethysmography) and blood pressure respectively. Treatment with Enalapril decreased the reflection of the retinal arterial wall significantly and reduced the narrowing of arteries and arterio-venous crossing phenomena non-significantly. Hydrochlorothiazide did not affect any of the retinal vascular changes. It can be concluded that this relatively simple technique of evaluating eye-ground-photos with a new grading scale, when used in non-malignant hypertension, gives a useful assessment of the degree of hypertensive target organ damage in the retina as well as in other important target organs, i.e. the heart and vascular beds. In addition, Enalapril positively affects hypertensive retinopathy in contrast to Hydrochlorothiazide, reflecting what happens to structural cardiovascular changes in the rest of the body.

Relationship between Left Yentricular Hypertrophy and Renal and Retinal Damage in Untreated Patients with Essential Hypertension.

“…The first important finding is that the incidences of proteinuria and advanced retinal Although it is well established that echocardiographicallydetermined LVH is the most important prognostic index of target organ damage in hypertensive patients, renal and retinal damage also has been shown to be important and to have prognostic significance (1)(2)(3)(13)(14)(15) The Framingham heart study demonstrated that in the ambulatory general population, proteinuria carries a substantial risk, with the mortality rate increased by three fold (15). Proteinuria was three times as commonin hypertensive persons, and was two times as commonin persons with electrocardiographicallydetermined LVH ( 1 5).…”

Essential Hypertension, Progressive Renal Disease, and Uric Acid

“…Finally, it is interesting that diuretics prevent hypertension in experimental hyperuricemia but, unlike angiotensin-converting enzyme inhibitors, do not block the development of the renal arteriolopathy (60). Similarly, a study in humans found that angiotensin-converting enzyme inhibitors are able to cause regression of retinal microvascular disease in hypertensive patients but diuretic therapy was without benefit (165). Again, these studies in composite suggest that diuretics, likely by raising uric acid levels and stimulating the renin angiotensin system, may accelerate the development of renal microvascular disease and thereby predispose the patient to renal progression.…”

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

“…Studies have demonstrated regression of hypertensive retinopathy signs in response to BP reduction and that regression is different in response to different antihypertensive regimens (eg, angiotensin-converting enzyme inhibitors seem to have a more favorable effect on the retinal vasculature). [109][110][111] Changes in retinal vasculature, markers of hypertensive state, may act as therapeutic targets capable of reflecting the effectiveness of antihypertensive drug treatment in controlling elevated BP values. Nevertheless, data describing the impact of antihypertensive therapy on retinal vascular changes are still lacking.…”