Hypertensive retinal changes: It’s prevalence and associations with other target organ damage

Abstract

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, \textit{P} = 0.002) and Grade I retinopathy with cerebrovascular morbidities (OR = 7.09 at 95% CI, \textit{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.