J Korean Neurosurg Soc.  2021 Jul;64(4):543-551. 10.3340/jkns.2020.0285.

Hypertensive Retinopathy and the Risk of Hemorrhagic Stroke

• Thiagarajah R
• Kandasamy R
• Sellamuthu P

• KMID: 2517687
• DOI: http://doi.org/10.3340/jkns.2020.0285

Abstract

Objective
: Hemorrhagic stroke (HS) and hypertensive retinopathy are known end organ damage of the brain and eye respectively, with HS having deleterious consequence to the patients. This study is to correlate between hypertensive retinopathy and HS in hypertensive disease.
Methods
: A control group of hypertensive patients only, and an investigated group of hypertensive HS patients. Fundoscopic examination to determine the grade of retinopathy was performed and then divided into low or high severity hypertensive retinopathy. Clinical and radiological parameter included are demography, vital signs, Glasgow coma scale (GCS) on admission, clot volume, site of clot, Intracerebral hemorrhage (ICH) score and Glasgow outcome scale (GOS). Data were correlated with the severity of hypertensive retinopathy.
Results
: Fifty patient in the control group and 51 patients in the investigated group were recruited. In the hypertensive HS group, 21 had low severity retinopathy (no or mild retinopathy) accounting for 41.2% and 30 patients had high severity (moderate or severe retinopathy). In the hypertensive patients 49 had low severity and one had high severity (p-value of 0.001). In HS group low severity showed better GCS score of 9–15 on admission (p-value of 0.003), clot volume less than 30 mL (p-value 0.001), and also a better 30 days mortality rate by using the ICH score (p-value 0.006), GOS score of 4 and 5 the low severity retinopathy fair better than the high severity retinopathy (p-value of 0.001), and the relative risk to develop HS in low severity and high severity retinopathy was 0.42 and 29.4, respectively.
Conclusion
: Hypertensive retinopathy screening could be used as an indicator in hypertensive patient, to evaluate the risk of developing hypertensive HS in the future.

Keyword

Hypertensive retinopathy; Hemorrhagic stroke

Reference

References

1. Baker ML, Hand PJ, Wang JJ, Wong TY. Retinal signs and stroke: revisiting the link between the eye and brain. Stroke. 39:1371–1379. 2008.

2. Edwards MS, Wilson DB, Craven TE, Stafford J, Fried LF, Wong TY, et al. Associations between retinal microvascular abnormalities and declining renal function in the elderly population: the Cardiovascular Health Study. Am J Kidney Dis. 46:214–224. 2005.

3. Kumar V, Abbas A, Fausto N. Robbins and Cotran Pathologic Basis of Disease. ed 7. Philadelphia: Elsevier;2005.

4. Liew G, Wong TY, Mitchell P, Cheung N, Wang JJ. Retinopathy predicts coronary heart disease mortality. Heart. 95:391–394. 2009.

5. Mondal RN, Matin MA, Rani M, Hossain ZM, Shaha AC, Singh RB, et al. Prevalence and risk factors of hypertensive retinopathy in hypertensive patients. J Hypertens (Los Angel). 6:241. 2017.

6. Ng WK, Goh KJ, George J, Tan CT, Biard A, Donnan GA. A comparative study of stroke subtypes between Asians and Caucasians in two hospital-based stroke registries. Neurol J Southeast Asia. 3:19–26. 1998.

7. Ong YT, Wong TY, Klein R, Klein BE, Mitchell P, Sharrett AR, et al. Hypertensive retinopathy and risk of stroke. Hypertension. 62:706–711. 2013.

8. Patton N, Aslam T, Macgillivray T, Pattie A, Deary IJ, Dhillon B. Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J Anat. 206:319–348. 2005.

9. Sabanayagam C, Shankar A, Klein BE, Lee KE, Muntner P, Nieto FJ, et al. Bidirectional association of retinal vessel diameters and estimated GFR decline: the BEaver Dam CKD Study. Am J Kidney Dis. 57:682–691. 2011.

10. Sairenchi T, Iso H, Yamagishi K, Irie F, Okubo Y, Gunji J, et al. Mild retinopathy is a risk factor for cardiovascular mortality in Japanese with and without hypertension: the Ibaraki Prefectural Health Study. Circulation. 124:2502–2511. 2011.

11. Tso MO, Jampol LM. Pathophysiology of hypertensive retinopathy. Ophthalmology. 89:1132–1145. 1982.

12. Wong T, Mitchell P. The eye in hypertension. Lancet. 369:425–435. 2007.

13. Wong TY, Coresh J, Klein R, Muntner P, Couper DJ, Sharrett AR, et al. Retinal microvascular abnormalities and renal dysfunction: the atherosclerosis risk in communities study. J Am Soc Nephrol. 15:2469–2476. 2004.