Retinal microvascular changes and target organ damage in untreated essential hypertensives

1
Retinal microvascular changes and target
organ damage inuntreated essential
hypertensives
Cesare Cuspidi, Stefano Meani, Maurizio
Salerno,Veronica Fusi,Barbara Severgnini,
Cristiana Valerio, Eleonora Catini, Arturo
Esposito,Fabio Magrini and Alberto Zanchetti
2
Detection of target organ damage (TOD) in
asymptomatic subjects with arterial hypertension
identifies a higher risk condition for
developing future cardiovascular (CV) events
partly independent of blood pressure (BP) levels.
which suggest a risk stratification based
not only on average BP levels, but also on the
presence or absence of other risk factors, TOD,
diabetes and CV and renal disease.
3
Classification of retinal vascular changes in
four grades has been used since Keith et al.
proposed it in the late 1930s, for grading
hypertensive retinopathy 10,11. In contrast
with the 1930s, when such classification was
formulated, advanced retinal lesions (grade 3
haemorrhages, exudates grade 4 papilloedema)
are rarely found nowadays, while grade 1
(arteriolar narrowing) and grade 2 (arteriovenous
crossings) are often observed 12.
4

• The current study was designed
• to investigate whether clinical detection of the
  initial eye ground changes in never-treated
  essential hypertensive individuals is
  significantly related with prognostically
  validated markersof cardiac and extracardiac TOD.
• With this purpose, we assessed the prevalence of
  
• LVH,
• carotid wall alterations and
• microalbuminuria
• among patients with and without arteriovenous
  crossings detected by qualitative examination of
  the fundus oculi using nonmydriatic retinography.

5
A total of 437 consecutive, never-treated
hypertensive patients referred to an outpatient
hospital clinic were included in the study. They
had (1) grade 1 and 2 hypertension (clinic BP
values between 90109 diastolic or BP 140179
mmHg systolic), confirmed during the first visit
at the outpatient clinic, (2) no history or
evidence of congestive heart failure, previous
myocardial infarction, cardiac valve disease,
history of coronary bypass, diabetes mellitus,
renal insufficiency, retinal haemorrhages or
exudates.
6

• All patients were subjected to the following
  diagnostic procedures within 14 weeks
• Repeated blood pressure (BP) measurements,
• (2) a 12-lead electrocardiogram at rest,
• (3) routine blood chemistry and urinalysis,
• (4) 24-h urine collection for microalbuminuria,
• (5) 24-h ambulatory BP monitoring (ABPM),
• (6) An echocardiogram,
• (7) a carotid ultrasonographic scan, and
• (8) non-mydriatic retinography.

7

• Definition of groups
• Patients were divided into two groups
• those with either a normal retinal pattern (no
  alteration detected in any eye ground quadrant)
  or diffuse arteriolar narrowing (group I)
• those with arteriovenous crossings (group II).

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13

• In conclusions,
• our study,
• the first carried-out in
• a large population
• of never-treated subjects
• with recently diagnosed
• grade 1 and 2 essential hypertension,
• indicates that

14

• fundoscopic examination,
• based on qualitative analysis of retinal
  photographs,
• has a limited value
• in detecting hypertensive patients with
  widespread TOD,

15
(2) arteriovenous crossings are not associated
with more prominent cardiac and extracardiac
TOD than diffuse arteriolar narrowings
16

• (3) use of grade 1, or even of only grade 2
• fundoscopic changes
• for
• stratifying total cardiovascular risk
• in
• hypertensive patients
• is likely to
• largely overestimate the proportion of
• patients at high risk of cardiovascular disease.

17
Grazie per lattenzione
WWW.mmjc.3000.it