HYPERTENSIVE RETINOPATHY GRADE IV IN AN 11-YEAR-OLD GIRL WITH RENAL ARTERIAL HYPERTENSION DUE TO RECURRENT REFLUX PYELONEPHRITIS

Funduscopic examination has long been recognized as the most affordable way to assess the condition of small diameter vessels. However, accumulation of new research data, changes in the requirements for the management of patients with various diseases require a return to the clinical, prognostic significance of fundoscopy and the specification of indications for its conduction in certain situations. This article discusses the prevalence of retinopathy depending on the etiological factor, criteria and stages of its development. Until now, a number of issues regarding retinopathy have not been finally resolved, in particular the classification optimal for routine practice, method of its study, etc. It is believed that changes in the fundus blood vessels reflect parallel changes in the vessels of other regions, but this is not always so. A moderate prognostic value of “mild” retinopathy has been established in terms of the risk of cardiovascular diseases, with moderate retinopathy, this relationship reaches a strong level, and with a malignant one, there is a strong correlation with death. The article discusses indications for fundoscopy in routine clinical practice, taking into account the latest scientific data and international recommendations. For the treatment of hypertensive retinopathy, only adequate control of blood pressure is recommended, which can reduce the signs of retinopathy. The authors concluded that the prognostic value of stage 1–2 hypertensive retinopathy is minimal and does not affect patient management. The latter eliminates the need for fundoscopy in patients with mild, controlled arterial hypertension, not suffering from diabetes, with the exception of young patients. Fundoscopy is required in patients with difficult-to-control and resistant arterial hypertension, high variability of blood pressure.

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HYPERTENSIVE ANGIORETINOPATHY IN A CHILD WITH PHEOCHROMOCYTOMA. CLINICAL CASE

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2018-13-4-189-192 ◽

2018 ◽

Vol 13 (4) ◽

pp. 189-192

Author(s):

E. V Denisova ◽

N. A Osipova ◽

L. A Katargina

Keyword(s):

Arterial Hypertension ◽

Treatment Strategy ◽

Clinical Case ◽

Interdisciplinary Cooperation ◽

Pathological Process ◽

Hypertensive Retinopathy ◽

Somatic Condition ◽

Comprehensive Examination ◽

The Right ◽

Hypertension In Children

Purpose: to present a clinical case of a child with hypertensive retinopathy developed against the background of undiagnosed pheochromacytoma and primarily regarded as neuroretinitis. The description of the case shows that a comprehensive examination of the child together with a pediatrician and endocrinologist allowed to identify the etiology of the pathological process and choose the right treatment strategy. Discussion. It is important to note that the alertness of the pediatric ophthalmologist in terms of the development of hypertensive retinal angiopathy is reduced. Arterial hypertension in children is much less common than in adults, and cases of hypertensive retinal lesions in children are rare. This can lead to a number of errors in the diagnosis and treatment of eye pathology, as well as underestimation of the severity of the General somatic condition of the child, in this connection it is important to emphasize the importance of close interdisciplinary cooperation in the examination and treatment of children of ophthalmic profile.

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Modern Aspects of Hypertensive Angioretinopathy

Ophthalmology in Russia ◽

10.18008/1816-5095-2018-4-470-475 ◽

2019 ◽

Vol 15 (4) ◽

pp. 470-475

Author(s):

L. K. Moshetova ◽

I. V. Vorobyeva ◽

A. Dgebuadze

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Retinal Disease ◽

Early Death ◽

Automated System ◽

World Health ◽

Hypertensive Retinopathy ◽

Special Importance ◽

Muscular Tissue

This literature review is devoted to modern problems of hypertensive retinopathy with arterial hypertension, as well as hypertensive retinopathy in combination diseases. The latest world studies were analyzed. Particular attention is paid to the clinical disease characteristics at the present stage with the analysis of the arterio-venous ratio, optic nerve edema (with high blood pressure figures) using an automated system, vector analysis, suggesting a new arteriovenous classification, called Web Integration (Wivern). The modern pathogenesis of hypertensive retinopathy, namely the ratio of proangiogenic and anti-angiogenic factors, the role of inflammation (C-reactive protein), the role of endothelin-1, endostatin, interleukin-8 (IL-8), and the main fibroblast growth factor (bFGF ), angiogenin and uric acid. The special importance of fundus registration is reflected with the help of the newest equipment at high figures of arterial pressure in patients with hypertensive retinopathy. It is known that according to the World Health Organization (WHO), mortality rate from cardiovascular diseases is 31 %. Hypertension is the main risk factor for coronary heart disease, myocardial infarction, heart failure, stroke, kidney disease and early death. Questions of eye blood flow in hypertensive angioretinopathy in patients with arterial hypertension (AH) are covered. Hypertensive retinopathy (HR) is a retinal disease that is caused by a prolonged increase blood pressure (BP) and leads to a decrease in vision. The data of pathophysiology are analyzed (arterial hypertension (AH) leads to thickening of the vessels of the inner membrane (intima), to thickening of the medial membrane (media) — hyperplasia of the muscular tissue followed by hyaline degeneration with the development of sclerotic changes). The questions of modern diagnostics with retinal morphological status evaluation (OCT), detection of eye fundus condition with newest fundus camers, pathogenetic aspects are discussed. This review will help to prevent the development of more severe forms of hypertensive retinopathy. This information will allow us to identify the most significant indicators in the early diagnosis of hypertension angioretinopathy.

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Stress and arterial hypertension - from pathophysiology to pharmacology

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh210323066n ◽

2021 ◽

pp. 66-66

Author(s):

Nemanja Nenezic ◽

Radomir Matunovic ◽

Ognjen Gudelj ◽

Ivica Djuric ◽

Jasna Jancic ◽

...

Keyword(s):

Arterial Hypertension ◽

Animal Studies ◽

Strong Association ◽

Antihypertensive Agents ◽

Angiotensin Converting Enzyme Inhibitors ◽

Hypertensive Retinopathy ◽

Channel Blockers ◽

Post Traumatic Stress ◽

Converting Enzyme Inhibitors ◽

Adrenergic Blockers

Arterial hypertension is the most massive chronic non-infectious disease of mankind nowadays. It may remain undiagnosed for years, provoking later complications, such as acute heart failure, cerebrovascular stroke, myocardial infarction, renal failure, hypertensive retinopathy, or sudden death. Primary arterial hypertension is more common, while secondary occurs in about 5-20% of cases. The recent studies have shown that stress may be a core factor in development of essential hypertension in some patients. For the patients suffering from post-traumatic stress disorder, stress is the dominant etiological factor that leads to the disease. It has been proven that chronic stress can affect blood pressure regulation and endocrine-metabolic functions through the limbic-hypothalamic centers, therefore it can affect the arterial hypertension development. The strong association between stress and arterial hypertension have been also confirmed in preclinical and animal studies. For the pharmacotherapy approach, the most important are beta-adrenergic blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors) and AT1-receptor blockers (sartans). As a second line treatment, calcium channel blockers, diuretics, alpha-adrenergic blockers, and central antihypertensive agents may be required. The anxiolytics, such as benzodiazepines, should be considered if chronic anxiety and psychosomatic disorders are present.

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