CROSS-SECTIONAL EVALUATION OF RETINAL CHANGES IN PATIENTS WITH UNCONTROLLED HYPERTENSION.

Nitish Kumar  Marshal; Rahul  Prasad; Priya  Suman; Komal  Soni

doi:10.51168/sjhrafrica.v6i6.1772

Authors

Dr. Nitish Kumar Marshal MS Department of opthalmology, RIO RIMS Ranchi
Dr. Rahul Prasad Associate Professor, Department of opthalmology, RIO RIMS, Ranchi
Dr. Priya Suman MS , Department of opthalmology, RIO, RIMS , Ranchi
Dr. Komal Soni MS , Department of opthalmology, RIO, RIMS , Ranchi

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1772

Keywords:

Hypertension, hypertensive retinopathy, retinal changes, fundus examination, cross-sectional study

Abstract

Background

Hypertension is a major global public health issue and a leading contributor to cardiovascular disease and stroke. Uncontrolled hypertension significantly affects microvascular structures, particularly in the retina, where visible alterations in the vasculature—termed hypertensive retinopathy—can serve as a non-invasive and early indicator of systemic vascular health. Regular retinal evaluations in hypertensive patients may offer vital clinical insights into the extent of end-organ damage and guide therapeutic interventions.

Objective

This study aimed to assess the prevalence and severity of retinal changes in patients with uncontrolled hypertension and examine correlations with clinical parameters such as age, duration of hypertension, and blood pressure severity.

Methods

A one-year cross-sectional observational study was conducted involving 100 patients diagnosed with uncontrolled hypertension (systolic BP >140 mmHg and/or diastolic BP >90 mmHg despite treatment). Fundus examinations were performed using both direct and indirect ophthalmoscopy, and retinal changes were classified according to the Keith-Wagener-Barker grading system. Clinical data including patient demographics, blood pressure readings, and duration of hypertension were collected and analyzed using SPSS software.

Results

Of the 100 participants, 62% were male, with the highest proportion (34%) aged between 51–60 years. The mean age was 58.2 ± 10.3 years, and the mean duration of hypertension was 8.6 ± 4.2 years. Retinal changes were present in 82% of the patients: 28% had Grade I, 32% Grade II, 18% had Grade III, and 4% had Grade IV hypertensive retinopathy. Significant associations were found between the severity of retinal changes and increasing age, longer disease duration, and higher blood pressure levels (p < 0.05).

Conclusion and Recommendation

The study highlights a strong correlation between hypertensive retinopathy and disease severity. Routine fundoscopic examinations should be integrated into hypertension management protocols to facilitate early detection of complications and improve patient outcomes.

Author Biographies

Dr. Nitish Kumar Marshal, MS Department of opthalmology, RIO RIMS Ranchi

Dr. Nitish Kumar Marshal is working as a junior Resident in the Department of ophthalmology at RIO RIMS Ranchi.

Dr. Rahul Prasad, Associate Professor, Department of opthalmology, RIO RIMS, Ranchi

Dr. Rahul Prasad is working as an Associate Professor in the Department of ophthalmology RIO RIMS Ranchi.

Dr. Priya Suman, MS , Department of opthalmology, RIO, RIMS , Ranchi

Dr. Priya Suman is working as a junior Resident in the Department of ophthalmology RIO RIMS Ranchi

Dr. Komal Soni, MS , Department of opthalmology, RIO, RIMS , Ranchi

Dr. Komal Soni is working as a junior Resident in the Department of ophthalmology RIO RIMS Ranchi.

References

M. Li et al., "Retinal ganglion cell complex thickness in subjects with diabetes mellitus and uncontrolled hypertension in China," BMC Ophthalmol., vol. 24, no. 1, p. 379, 2024.https://doi.org/10.1186/s12886-024-03644-x

PMid:39192272 PMCid:PMC11351316

M. A. Ahmed, H. M. Hegazy, and E. N. Abbas, "Assessment of Juxta Papillary Retinal Fiber Layer in Normal Blood Pressure, Controlled and Uncontrolled Hypertensive Patients," Al-Azhar Int. Med. J., vol. 5, no. 5, pp. 43, 2024.

https://doi.org/10.58675/2682-339X.2445

A. Gallo, T. Dietenbeck, A. Giron, M. Paques, N. Kachenoura, and X. Girerd, "Non-invasive evaluation of retinal vascular remodeling and hypertrophy in humans: intricate effect of ageing, blood pressure and glycaemia," Clin. Res. Cardiol., vol. 110, pp. 959-970, Jul. 2021. https://doi.org/10.1007/s00392-020-01680-3 PMid:32494923

W. Tan et al., "The new era of retinal imaging in hypertensive patients," Asia-Pac. J. Ophthalmol., vol. 11, no. 2, pp. 149-159, Mar. 2022. https://doi.org/10.1097/APO.0000000000000509 PMid:35533334

P. Nichani and J. A. Micieli, "Retinal manifestations of idiopathic intracranial hypertension," Ophthalmol. Retina, vol. 5, no. 5, pp. 429-437, May 2021. https://doi.org/10.1016/j.oret.2020.08.016 PMid:32860958

J. Chua, C. Y. Cheung, L. Schmetterer, and T. Y. Wong, "Hypertensive fundus changes," in Retinal Vascular Disease, 2020, pp. 85-97.https://doi.org/10.1007/978-981-15-4075-2_9

L. Jiao, C. Lv, and H. Zhang, "Effect of blood pressure variability on hypertensive retinopathy," Clin. Exp. Hypertens., vol. 45, no. 1, p. 2205050, Dec. 2023. https://doi.org/10.1080/10641963.2023.2205050 PMid:37120839

C. S. Lee, E. Y. Choi, M. Lee, H. Kim, and H. Chung, "Serous retinal detachment in preeclampsia and malignant hypertension," Eye, vol. 33, no. 11, pp. 1707-1714, Nov. 2019. https://doi.org/10.1038/s41433-019-0461-8

PMid:31089238 PMCid:PMC7002678

A. Bosch et al., "Renal denervation reduces retinal arterial remodeling in patients with treatment resistant hypertension and type 2 diabetes mellitus," J. Hypertens., vol. 41, Suppl. 3, pp. e296-e297, Jun. 2023.

https://doi.org/10.1097/01.hjh.0000942092.39126.65

R. Zeng et al., "Retinal microvasculature and vasoreactivity changes in hypertension using optical coherence tomography-angiography," Graefe's Arch. Clin. Exp. Ophthalmol., vol. 260, no. 11, pp. 3505-3515, Nov. 2022.

https://doi.org/10.1007/s00417-022-05706-6 PMid:35678840

K. Y. Nam et al., "Different characteristics of retinal damage between chronic hypertension and hypertensive retinopathy," Sci. Rep., vol. 12, no. 1, p. 18902, Nov. 2022. https://doi.org/10.1038/s41598-022-23756-y

PMid:36344638 PMCid:PMC9640608

W. R. Kwapong et al., "Retinal microvascular and structural changes in intracranial hypertension patients correlate with intracranial pressure," CNS Neurosci. Ther., vol. 29, no. 12, pp. 4093-4101, Dec. 2023.

https://doi.org/10.1111/cns.14298 PMid:37287365 PMCid:PMC10651994

C. Manole, B. Tabacaru, C. Danielescu, and H. T. Stanca, "Retinal vascular impact in systemic hypertension," Med.-Surg. J., vol. 124, no. 4, pp. 628-637, Dec. 2020.

S. A. Avila, C. Golshani, and A. H. Friedman, "Hypertensive crisis with massive retinal and choroidal infarction: a case update," Am. J. Ophthalmol. Case Rep., vol. 13, pp. 22-24, Mar. 2019.

https://doi.org/10.1016/j.ajoc.2018.11.003 PMid:30519668 PMCid:PMC6260392

R. H. Abu Sbeit, O. A. Mohammed, and L. I. Alamlih, "Hypertension as an unusual cause of proliferative retinopathy: Case report and literature review," Case Rep. Ophthalmol., vol. 12, no. 2, pp. 594-602, Sep. 2021.

https://doi.org/10.1159/000515284 PMid:34326759 PMCid:PMC8299402