J Korean Ophthalmol Soc.  2010 Sep;51(9):1231-1236. 10.3341/jkos.2010.51.9.1231.

Hypertensive Retinopathy and Associated Target Organ Damage in Korean Hypertensive Patients

• Kang S
• Roh YJ
• Moon JI

• KMID: 2122290
• DOI: http://doi.org/10.3341/jkos.2010.51.9.1231

Abstract

PURPOSE
To report the relationship between hypertensive retinopathy and associated target organ damage in Korean hypertensive patients.
METHODS
A total of 519 hypertensive patients were divided into hypertension retinopathy grades I through IV based on fundus examination. According to the grade of each hypertensive retinopathy, the frequency of target organ damage (cardiovascular disease, chronic kidney disease, and retinal vessel occlusion) and the association with hypertension retinopathy were evaluated.
RESULTS
There were 211 patients (40.7%) without hypertensive retinopathy, 226 patients (43.5%) with hypertensive retinopathy grade I, 71 patients (13.7%) with grade II, seven patients (1.3%) with grade III and four patients (0.8%) with grade IV. The numbers of patients with cardiovascular disease were 103 (45.6%) in grade I, 57 (80.3%) in grade II, 3 (42.9%) in grade III, two (50.0%) in grade IV, and 70 (37.4%) in the non-hypertensive retinopathy group. According to four grades, the numbers of patients with cerebrovascular disease were three (1.3%), two (2.8%), zero (0%), and one (25.0%), respectively, with two (0.9%) in the non-hypertensive retinopathy patients. The respective numbers of patients with chronic kidney according to grades I through IV were 14 (6.2%), ten (14.0%), two (28.6%), and four (100.0%), as well as ten (4.7%) in the non-hypertensive retinopathy patients. The respective numbers of patients with retinal vessel occlusion were one (0.4%), two (2.8%), one (14.3%), and one (25.0%), with zero (0%) in the non-hypertensive retinopathy patients.
CONCLUSIONS
The significance of hypertensive retinopathy should not be overlooked in Korean hypertensive patients due to an association with various target organ damage.

Keyword

Hypertension; Hypertensive retinopathy; Target organ damage

MeSH Terms

Cardiovascular Diseases
Glycosaminoglycans
Humans
Hypertension
Hypertensive Retinopathy
Kidney
Renal Insufficiency, Chronic
Retinal Vessels
Glycosaminoglycans

Reference

1. Williams B, Poulter NR, Brown MJ, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): Summary. BMJ. 2004. 328:634–640.

2. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003. 42:1206–1252.

3. Svärsudd K, Wedel H, Aurell E, Tibblin G. Hypertensive eye ground changes: prevalence, relation to blood pressure and prognostic importance. Acta Med Scand. 1978. 204:159–167.

4. Tanaka H, Hayashi M, Date C, et al. Epidemiolgic studies of stroke in Shibata, a Japanese provincial city: preliminary report on risk factors for cerebral infaction. Stroke. 1985. 16:773–780.

5. Nakayama T, Date C, Yokoyama T, et al. A 15.5-year follow-up study of stroke in a Japanese provincial city. The Shibata Study. Stroke. 1997. 28:45–52.

6. Breslin DJ, Gifford RW Jr, Fairbairn JF 2nd. Essential hypertension. A twenty year follow-up study. Circulation. 1966. 33:87–97.

7. Michelson EL, Morganroth J, Nichols CW, MacVaugh H 3rd. Retinal arteriolar changes as an indicator of coronary artery disease. Arch Intern Med. 1979. 139:1139–1141.

8. Duncan BB, Wong TY, Tyroler HA, et al. Hypertensive retinopathy and incident coronary heart disease in high risk men. Br J Ophthalmol. 2002. 86:1002–1006.

9. Wong TY, Klein R, Sharret AR, et al. Retinal arteriolar narrowing and incident coronary heart disease in men and women: The Atherosclerosis Risk in the Communities Study. JAMA. 2002. 287:1153–1159.

10. Keith NM, Wagener HP, Barker NW. Some different types of essential hypertension: their course and prognosis. Am J Med Sci. 1974. 268:336–345.

11. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens. 1999. 17:151–183.

12. Ramsay LE, Williams B, Johnston GD, et al. British Hypertension Society guidelines for hypertension management 1999: Summary. BMJ. 1999. 319:630–635.

13. August P. Initial treatment of hypertension. N Engl J Med. 2003. 348:610–617.

14. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997. 157:2413–2446.

15. Dodson PM, Lip GY, Eames SM, et al. Hypertensive retinopathy: a review of existing classification systems and a suggestion for a simplified grading system. J Hum Hypertens. 1996. 10:93–98.

16. Schubert HD. Ocular manifestations of systemic hypertension. Curr Opin Ophthalmol. 1998. 9:69–72.

17. Wong TY, Klein R, Klein BE, et al. Retinal microvascular abnormalities, and their relationship with hypertension, cardiovascular disease, and mortality. Surv Ophthalmol. 2001. 46:59–80.

18. Chatterjee S, Chattopadhyay S, Hope-Ross M, Lip PL. Hypertension and the eye: changing perspectives. J Hum Hypertens. 2002. 16:667–675.

19. Van den Born BJ, Hulsman CA, Hoekstra JB, et al. Value of routine funduscopy in patients with hypertension: systemic review. BMJ. 2005. 331:73.

20. Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003. 21:1011–1053.

21. World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003. 21:1983–1992.

22. Gillum RF. Retinal arteriolar findings and coronary heart disease. Am Heart J. 1991. 122:262–263.

23. Cuspidi C, Meani S, Valerio C, et al. Prevalence and correlates of advanced retinopathy in a large selected hypertensive population. The Evaluation of Target Organ Damage in Hypertension (ETODH) study. Blood Press. 2005. 14:25–31.

24. Goto I, Katsuki S, Ikui H, et al. Pathological studies on the intracerebral and retinal arteries in cerebrovascular and noncerebrovascular diseases. Stroke. 1975. 6:263–269.

25. Wong TY, Klein R, Sharrett AR, et al. The prevalence and risk factors of retinal microvascular abnormalities in older people: the Cardiovascular Health Study. Ophthalmology. 2003. 110:658–666.