Lecture 5 - HTN and Ocular Complications Flashcards
what is normal BP for anyone younger than 60?
less than 140/90
what is normal BP for anyone with DM or CKD?
less than 140/90
what is normal BP for anyone older than 60 years old?
less than 150/90
what is a hypertensive crisis BP?
greater than 180/ 100
what are some symptoms related to end organ damage in HTN patients?
TIA, amourosis fugax, chronic kidney infections, polyuria, dyspnea, peripheral edema
what are some risk factors for HTN (modifiable)?
obesity (apple shape), salt intake, smoking/alcohol, physical inactivity, fatty diets/increased cholesterol, stress, metabolic syndrome
what happens to the heart with HTN?
the left ventricle becomes larger due to an increased resistance - fluid builds up in the lungs and peripheral body
what signs of HTN do you look for in the pre-testing part of the exam?
BP, EOMs (palsies), pupils (APD), BVA (macular involvement), SLEx (NVI and AC reaction) and DFE
what are some ocular diseases that occur secondary to HTN?
hypertensive retinopathy, vein occlusions, artery occlusions, CN3/CN4/CN6 palsies (CN6 higher than DM), OIS, macroaneurysm, sub-conjunctival hemorrhage, AION, and hypertensive choroidopathy
what is considered grade 1 hypertensive retinopathy?
mild increased ALR and mild arteriole narrowing
what is considered grade 2 hypertensive retinopathy?
more pronounced arteriole narrowing, AV ratio changes, focal constriction, AV crossing changes
what is considered grade 3 hypertensive retinopathy?
grade 2 + CWS, hemorrhages, exudates
what is considered grade 4 hypertensive retinopathy?
grade 3 + optic disc swelling
what is considered mild hypertensive retinopathy?
increased ALR, AV ratio changes, AV crossing changes, focal narrowing (diastolic >90 and >110)
what is considered moderate hypertensive retinopathy?
hemorrhages, CWS, hard exudates, aneurysms (diastolic BP >110)
what is considered severe hypertensive retinopathy?
moderate findings + ON swelling (diastolic BP > 110)
what is hypertensive encephalopathy?
the brain is swollen = severe HTN, headaches, nausea, +/- vomiting, papilledema and accelerated BP (perform crainial nerve assessment)
what is the pathogenesis of the vascular response in the chronic phase?
vasoconstrictive state - sclerotic state - exudative state
what happens in the vasoconstrictive state of the chronic phase?
initial response is vasoconstriction - generalized narrowing of arterioles, decrease in AV ratio (heart is working harder to excrete sodium/water)
what happens in the sclerotic state of the chronic phase?
persistently elevated BP causes hyperplasia and thickening of arteriole wall - increase in ALR and AV crossing changes (compression, deflection, humping, tapering)
what happens in the exudative state of the chronic phase?
when autoregulation fails and the high BP is transmitted to the capillaries - hemorrhages, CWS, hard yellow exudates, optic nerve swelling
what is the pathogenesis of the vascular response in the accelerated phase?
the upper limit of the retinal and cerebral vessel’s autoregulation is breeched = vasodilation, hyperperfusion, edema, retinopathy and/or encephalopathy
what did the ARIC (atherosclerosis risk in communities study) conclude?
generalized arteriolar narrowing and AV nicking have been associated with an increase in stroke and heart disease (2-3x greater risk when CWS, hemes or exudates)
what retinal signs indicate an emergent case of HTN?
bilateral disc edema and macular star (exudates)
what is hypertensive choroidopathy?
(rare) marked elevation in systemic BP - autonomic regulatory capacity exceeded - fibrin-platelet obstruction - obstruction of arteries and choriocapillaries - necrosis of RPE and fibrinous exudation
when is hypertensive choroidopathy seen?
associated with moderate-severe HTN retinopathy, younger patients (may be caused by adrenal gland tumor) >220/120 BP
what are the retinal signs of hypertensive choroidopathy?
Siegrist streaks (linear hyperpigmented areas over choroidal vessels) and Elschnig spots (changes in RPE from non-perfused areas in choriocapillaris = moth eaten appearance)
which ethnicity has a higher prevalence of HTN retinopathy?
2x as frequent in african americans vs. caucasians
what is the follow up recommendation for mild HTN retinopathy?
less than 140/90 = RTC in 1-2 years
what is the follow up recommendation for moderate HTN retinopathy?
(>140-180/>90-110) = RTC in 3-6 months and MD in 2-4 weeks
what is the BP for a HTN crisis?
> 180/>110 + acute TOD
what is a hypertensive urgency?
(>180/>110) severe BP, may have headaches, no progressive TOD, and no disc edmea