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Purpose: To evaluate the role of hyperlipidemia on fundus changes in hypertensive patients and to correlate the above findings with components of lipid profile. Materials and Methods: A cross-sectional study was carried out in 100 patients who were diagnosed to have systemic hypertension. Patients suffering from diabetes, high myopia, patients with...
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Citations
... Similar findings were reported in studies by Mondal R et al. 23 27 and Modi P et al. 28 showed a female preponderance. However, studies by S Ray et al. 25 and Gupta et al. 29 noted no significant gender bias in hypertensive retinopathy prevalence. This variation in gender distribution may be attributed to risk factors, particularly the higher prevalence of smoking among men in our study. ...
Persistently raised blood pressure not only leads to retinal vascular damage but also leads to systemic diseases. The retinal vasculature observation by fundoscopy offers a great opportunity to explore the association of systemic microvascular disease caused by hypertension. Hypertensive retinopathy (HR) is considered to be a marker for vascular disease and death.
The aim of the present study was to find out the prevalence of hypertensive retinopathy among hypertensive subjects and assess the pattern of retinopathy and associated risk factors.
This was a hospital based cross-sectional study conducted among hypertensive patients at a teaching hospital, for a period of 3 months.
A total of 300 hypertensive patients formed the study population. The prevalence of the hypertensive retinopathy in the present study was 49.33%. Hypertensive retinopathy was more prevalent in men 62% than women 38%. The prevalence of grade 1 and grade 2 hypertensive retinopathies was 43.24% and 33.11% respectively and 20.95% and 2.7% had grade 3 and 4 respectively. The prevalence of retinopathy was found to be statistically higher in patients who had h/o hypertension for more than 5 years. The prevalence of hypertensive retinopathy was more common in age group >60yrs. The prevalence of target organ damage was higher in those having retinopathy.
The prevalence of hypertensive retinopathy is high in the present study which reflects lack of awareness, patient compliance, sub optimal measures to control blood pressure and even lack of prompt follow up with ophthalmologists. There is need to spread awareness and take adequate measures to reduce the burden of hypertensive retinopathy.
... 8 In another study, Gupta R P et al9 also showed that there was an increased incidence of hypertensive retinopathy in patients having high serum cholesterol level and this association was statistically significant (P < 0.0008). 9 Similarly, Bastola et al in their study, also showed that there was a statistically significant difference in the mean serum cholesterol level (F = 10.38; P < 0.001) of patients with normal fundus and in those with different grades of hypertensive retinopathy. ...
The incidence of hypercholesterolemia is ever increasing as the co morbid conditions such as diabetes mellitus, hypertension, stressful life is on a rise. Ocular conditions associated with hypercholesterolemia are issues which are minimally discussed.
: This prospective cross-sectional study was conducted from January 2019 to June 2019. Complete eye examination was performed including visual acuity examination, refraction, tear film evaluation, slit lamp examination, measurement of intraocular pressure using rebound tonometer, gonioscopy, direct and indirect ophthalmoscopy
Total of 81 patients were examined, out of which males were 55, females were 26. Most common ocular finding was Xanthoma and Xanthelasma in 61(70%) patients. Arcus juvenalis was noted in 12 (14.63%), Lipid keratopathy in 23(29.26%). Other comorbidities associated were Hypertensive Retinopathy, diabetic retinopathy, Pre senile cataract, Primary open angle Glaucoma, Branch retinal vein occlusion which has indirect causal relationship.
Along with systemic workup, Hypercholesterolemia also warrants a routine detailed ocular examination even if the patient is asymptomatic. This aids in early diagnosis and management of the co-existing ocular morbidities.
... In this study, we found that the proportion of patients with elevated TG was significantly higher in the hypertensive retinopathy group than in patients without retinopathy. Similarly, Gupta et al. (33) found a positive association of TG with hypertensive retinopathy in adults. However, the pathogenesis is still unclear, and further studies are needed to ascertain the association of TG and hypertensive retinopathy. ...
Objective: The aim of this study was to investigate the clinical characteristics and factors associated with pediatric hypertension and target organ damage (TOD).
Methods: We retrospectively reviewed clinical data from 205 children with hypertension treated in our hospital from 2007 to 2018. The patients were classified based on the type of hypertension (primary, secondary) and presence of TOD (heart, brain, retina). Logistic regression analysis was performed to identify the factors independently associated with hypertension and TOD.
Results: There were 107 males, 97 females, and one intersex in this study, with an age range of 0.1–17.9 years. Majority of cases (177, 86.3%) had secondary hypertension, while 13.7% had primary hypertension. The most frequent cause of secondary hypertension was renal disease (59.32%). Elevated serum creatinine level (odds ratio [OR] = 7.22, 95% confidence interval [95% CI] = 1.6–32.62, P = 0.01), blood urea nitrogen (OR = 6.33, 95% CI = 1.81–22.19, P = 0.004), serum uric acid level (OR = 3.66, 95% CI = 1.20–11.22, P = 0.023), and albuminuria (OR = 3.72, 95% CI = 1.50–9.26, P = 0.005) were independently associated with secondary hypertension. Elevated serum uric acid and blood urea nitrogen levels were associated with left ventricular hypertrophy (OR = 6.638, 95% CI = 1.349–32.657, P = 0.02) and hypertensive encephalopathy (OR = 4.384, 95% CI = 1.148–16.746, P = 0.031), respectively. Triglyceride level correlated with hypertensive retinopathy ( P = 0.001).
Conclusion: Pediatric hypertension was most often secondary, with renal disease as the leading cause. Elevated levels of serum uric acid, blood urea nitrogen, serum creatinine, and albuminuria may indicate secondary hypertension in childhood. Elevated serum uric acid, blood urea nitrogen, and triglyceride levels were associated with left ventricular hypertrophy, hypertensive encephalopathy, and hypertensive retinopathy, respectively.
... It is well-known that HR is a multitarget pathology. Recent studies have demonstrated that the pathology of HR is clearly more complicated than simply high identified a statistically significant difference in mean triglyceride level for different degree of HR, highlighting their consequent augmentation through stages [28] [29]. Another research performed by Akhter et al. (2013) presented data that illustrated that increased serum cholesterol and serum triglyceride, were found to be significant risk indicators for developing retinopathy in the population [30]. ...
... Still the data revealed an increase in total cholesterol, TAG and LDL-Chol levels and a decrease in HDL-Chol as HR pro-Journal of Biosciences and Medicines gressed [15]. There are studies that have shown a positive correlation between LDL-Chol, HDL-Chol and HR [28] [32], however, this study just as the study by Gupta et al. [29] did not reveal a connection between them. Low HDL-Chol and high TAG levels induce an enhancement in small HDL particles, as well as an elevation in small, dense LDL-Chol particles [33]. ...
... In 2012, Bastola et al. demonstrated a significant difference in the mean serumcholesterol level in all four stages of HR with a p < 0.001[28]. And the result of our research also supports the findings of the study conducted by Gupta et al.(2013), that proved a positive correlation of HR with total cholesterol content (p < 0.002), with a gradual increase of the cholesterol level in parallel with the evolution in grade of HR[29].Resembled outcomes with our study were remarked and regarding TAG. Inthe mentioned above Bastola et al. (2012) and Gupta et al. (2013) articles, was ...
Background. Hypertension (HTN) is a preventable risk factor for morbidity and mortality worldwide. Hypertensive retinopathy (HR), its ocular compli-cation, is characterized by progressive metabolic disorders and structural damage of the retina. Lipids play an essential role in retina homeostasis, so an alteration of lipid metabolism specific for HTN may be of great significance in the development of hypertensive retinal injury. The study aimed to inves-tigate the association between HR, traditional lipid biomarkers changes, and the atherogenic index, as well as to highlight a possible role of lipid metabol-ism markers in HR diagnosis and prognosis. Methods. A total of 90 hyper-tensive patients from the Republic of Moldova, admitted to the Ovisus Medi-cal Center, Chisinau, Republic of Moldova, for a vision check and firstly di-agnosed with HR were recruited in our study. The enrolment period is be-tween February 2018 and December 2019. They were divided into three groups based on fundoscopy, using Keith-Wagner-Barker grading system of HR—GI: 36 patients; GII: 35 patients; GIII: 19 patients. The level of serum li-pids: triglycerides, total cholesterol, LDL-Chol, and HDL-Chol was deter-mined, followed by the calculation of the atherogenic index of plasma. Results are displayed as the median and interquartile range (IQR). Kolmogorov-Smirnov and Shapiro-Wilk normality tests were used, followed by Levene’s homo-geneity of variance test. The groups were compared using the non-parametric Kruskal-Wallis and Mann-Whitney tests. The Spearman correlation coeffi-cient was calculated (SPSS 23.0): p < 0.05—statistically significant. Results. It was attested a statistically significant increase of serum total cholesterol levels between the groups as the HR advanced (p = 0.017). In paired group compar-isons, the total cholesterol level in GII significantly enhanced compared to GI 5.63 (IQR 0.69) mM/L vs. 5.49 (IQR 0.51) mM/L, p = 0.05 and in GIII compared to GI 5.76 (IQR 0.82) μM/L vs. 5.49 (IQR 0.51) mM/L, p = 0.04, show-ing a significant weak positive correlation with the degree of HR (r = 0.292**, p = 0.005). A resembled tendency to increase was highlighted also in serum TAG levels between groups (p = 0.061), with a significant weak and positive correlation with the degree of HR (r = 0.249*, p = 0.018). The results for HDL-Chol, LDL-Chol and atherogenic index were insignificant. Conclusion. The study revealed statistically conclusive changes associated with the HR degree of the TAG and total cholesterol levels and the absence of changes in plasma lipoprotein content—LDL-Chol and HDL-Chol. Extended research is mandatory to conclude the role of lipid metabolism in the advancement of HR and to ascertain the potential diagnostic importance of the presented lipid status changes.
... Among Indian studies that correlate hypertensive retinopathy with hypertensive systemic complications, study by Singh et al. showed age distribution pattern was similar to our study in essential hypertension and hypertensive [10] In our study, 62.25% of patients had hypertensive retinopathy changes which corroborates with the findings of Gupta et al. [11] In an extensive literature search, the highest level of prevalence of hypertensive retinopathy among hypertensives was found among Congolese patients leading to peak level of 83.6%. [12] About 65.4% of males and 61.2% of females had retinopathy. ...
Objectives
This study enlightens association of different cerebrovascular, cardiovascular, and renal morbidities with hypertensive retinopathy which is very much relevant in the present scenario, especially in India, where the prevalence of hypertension is very high. The objectives of the study were to estimate the prevalence, association, and severity of hypertensive retinal changes among patients with other target organ damage (TOD) such as cardiovascular or cerebrovascular or renal morbidities.
Material and Methods
A cross-sectional descriptive observational study was carried out after doing systemic random sampling involving 416 study participants having a history of hypertensive cerebrovascular, cardiovascular, and renal damages include history of stroke, acute coronary syndromes, left ventricular hypertrophy, and chronic kidney disease which were examined by direct ophthalmoscopy findings and classified according to the Scheie classification throughout the past 1 year in OPD of our institution.
Results
Hypertensive retinopathy was present in 259 patients (62.25%) out of 416 participants (Grade I: 13.5%, Grade II: 26.9%, Grade III: 18.5%, and Grade IV: 3.4%). Among the variables associated with hypertensive retinopathy, it was seen that 209 (63.3%) subjects present with features of hypertensive retinopathy are more than 50 years of age. No significant association was found between hypertensive retinopathy and presence or absence of cardiovascular morbidities, cerebrovascular morbidities, and renal morbidities. However, the subgroup analysis shows that significant association was found between Grade IV hypertensive retinopathy with renal morbidities (odds ratio [OR] = 5.83 at 95% CI, P = 0.002) and Grade I retinopathy with cerebrovascular morbidities (OR = 7.09 at 95% CI, P = 0.000).
Conclusion
Severe grades of retinopathy can be an indicator of renal morbidity, whereas earlier grades of retinopathy can be predictor of acute cerebrovascular events. Physicians should adopt holistic approach to evaluate TODs and screen them adequately in all hypertensives.
... In this study, we found that dyslipidemia was signicantly associated with retinopathy. Gupta et al showed that the increasing level of serum LDL-cholesterol had statistically signicant correlation with the grades of 15 hypertensive retinopathy (P < 0.0001). ...
Introduction: Hypertensive retinopathy is among the vascular complications of essential hypertension. It is known that the auto-regulation of retinal circulation fails as blood pressure increases beyond a critical limit. There is a paucity of data of retinopathy in newly diagnosed elderly hypertensive patients (>60 years) in India. Aim: To assess retinopathy in newly diagnosed elderly hypertensive patients (>60 years) at Dr RPGMC Kangra at Tanda. Methods: One hundred patients above 60 year of age newly diagnosed with hypertension and presenting to outpatient clinic of Department of Medicine, Dr RPGMC Kangra were included. Statistical analysis was performed using SPSS v21.0 (IBM, USA). Results: 30% patients had retinopathy; 21% had hypertensive retinopathy (5% grade 1, 12% grade 2, and 4% grade 3) while 9% had bilateral non-proliferative diabetic retinopathy (NPDR) with hypertensive retinopathy. Age, sex, BMI, diet, smoking and alcohol consumption were not associated with retinopathy. There was a significant higher number of retinopathy patients were diabetic (11/30 vs. 8/70; P=0.003). There were a significantly higher proportion of retinopathy in patients with chronic kidney disease (P=0.003). There were a significant number of patients with dyslipidemia among retinopathy patients (P<0.05). Increasing stage of hypertension was associated with retinopathy. Conclusion: This study proved a definite association between dyslipidemia, diabetes, and CKD and hypertension with retinopathy in newly diagnosed elderly hypertensive patients.
... Beside retinopathy patients, there were another 32.2% adults of other diseases. The different health hazards were significantly associated with level of hypertension [ 18% more exposed to this health problem[ R.R.=1.18,C.I.(0.61,2.27)}, though gender variation and prevalence of hypertensive retinopathy were not significantly associated [ =0.254, p -value=0.614]. ...
... Mean age group of the study conducted by Senghor et al [5] was 52.77± 6.3 years. Bastola P et al [2] had mean age of 58.5±9.2 years, also Rajendra et al [6] had a mean age of 56.50±21.00 years in their study. ...
... IJBR (2019) 10 (08) Page 4 of 5 www.ssjournals.com [2] and Gupta et al [6] also showed similar pattern. Though HDL is known to have antiatherogenic property [23] it did not show relation with hypertensive retinopathy. ...
... Normal VLDL was found in 63% of subjects and only 37% had abnormal VLDL. There was no statistically significant relationship between VLDL andhypertensive retinopathy (p 0.603) which was similar to study conducted by Bastola et al [2] and Gupta et al [6]. ...
... Previous studies have shown an association between hypertensive retinopathy and hypertriglyceridemia in populations from Nepal and India. In addition, the studies conducted on the Nepalese and the populations from India were conducted with patients that had already been diagnosed with hypertension at the time of the study and were seeking care [13,64,65]. ...
Understanding disease risk is challenging in multifactorial conditions as it can differ by environment, ethnicity and race. The Confederated Tribes of the Goshute Reservation are one of the most isolated populations in the United States. Retinal changes are a reliable indicator for systemic disease. We conducted a cross-sectional study to identify correlations between genetic data and epidemiological risk factors for blinding retinal disease in this tribe. As part of the "Supporting Prediction and Prevention Blindness Project (SPBPP)" in the Native American Population of the Intermountain West, we found that hypertensive retinopathy was the most prevalent retinal disease. We found that forty-two percent of the Goshute population was affected. Blood samples, fundus photos and intraocular pressure were obtained for all participants. In addition, a standardized questionnaire was administered. DNA and total cholesterol, HDL, LDL, VLDL, triglycerides and HbA1c were also evaluated. Our study interrogated genetic variants from the PAGE study (ARMS2 rs10490924, CFH rs800292, rs1061170) and additional studies that looked at previously associated genetic variants with retinal disease associated with cardiovascular disease. We conducted univariate and multivariate logistic regression in Stata v15.0. We found an association between hypertriglyceridemia and HTR (adjp = .05) within the Goshute population. To the best of our knowledge, this is the first study to demonstrate the prevalence of hypertensive retinopathy in a Native American population. Moreover, our study is the first to demonstrate an independently predictive relationship between hypertriglyceridemia and hypertensive retinopathy in an American Indian population. This study furthers our knowledge about prevalent blinding eye disease within the most geographically isolated federally recognized native United States American tribe, for which nothing has been published with respect to any disease. Although, this study furthers our understanding about the prevalence of genetic epidemiological risk factors within this population, it has greater implications for the screening of blinding diseases in underserved populations in general. This study can inform public health on planning and delivering of quality, accessible and relevant care to this population.
... In the study conducted by Gupta et al, in patients with essential HTN, hypertensive retinopathy was seen in 83.78% (n= 37) of patients with age more than 60 years. 18 In the study conducted by Gadkari et al, in patients with DM, DR was seen in patients within the age group of 60-80 years and >80years was 25.04% (n=1789) and 23.21% (n=56). 19 ...
Background: Hypertension (HTN) and Diabetes mellitus (DM) are the leading contributors to the cardiovascular mortality and morbidity. Drug utilisation studies (DUS) are potential tools in the evaluation in health care systems. Objectives was to analyse the drug usage pattern of anti-hypertensives in elderly hypertensive diabetic in-patients in a tertiary hospital. To analyse drug usage pattern of anti-hypertensives in elderly hypertensive, diabetic in-patients with renal impairment in a tertiary hospital.Methods: The study population consisted of 165 hypertensive diabetic in-patients at Shri Dharmasthala Manjunatheshwara (SDM) Hospital. Questionnaire based study was conducted and prescriptions of patient with HTN and DM at and above the age of 60 years irrespective of gender were included.Results: Our study revealed that angiotensin receptor blockers (ARBs) were the most commonly prescribed (42.4%) class of anti-hypertensive drugs. In patients with impaired renal function also ARBs were the most common class prescribed (22.0%). Out of 35 anti-hypertensive fixed drug combinations (FDCs) prescribed the most frequent combination was combination with an ARBs (85.7%). There was a significant increase in the number of anti-hypertensive drugs prescribed in patients with impaired renal function when compared to patients without impaired renal function (p <0.05). The cost index was high, and the percentage cost variation was more than 100% in most of the anti-hypertensive drugs prescribed.Conclusions: This study shows that the most commonly prescribed anti-hypertensive drug class was ARBs in patients with and in patients without impaired renal function.
