Hypertensive angiopathy

Hypertensive angiopathy is a consequence of a long-term hypertensive disease, as a rule, I-IIB stage.

The disease is characterized by the widening of the venous vessels of the fundus, the change in their tortuosity, the appearance of the branching of the vascular bed, the disproportionality of the arteries' lumen, the possibility of pinpoint hemorrhages. If such a disease is found, an emergency treatment is required, otherwise the patient may lose sight partially or completely.

[1], [2],

Causes of hypertensive angiopathy

Hypertensive angiopathy appears due to prolonged hypertension - chronically high blood pressure. High pressure is considered if its systolic values are equal to or exceed 140 mmHg, and diastolic values are equal to or exceed 90 mmHg.

The reasons for this condition can be many, and, first of all, this is a hereditary predisposition, excessive body weight, the presence of bad habits, lack of physical activity, the use of excessively salty foods, a lack of magnesium and potassium in the body.

Sometimes the arterial pressure rises, as a result of other diseases and pathological conditions: these are disorders of the endocrine function, CNS pathology, etc.

A prolonged state of high blood pressure causes structural disturbance in the vascular wall, which leads to a deterioration of blood supply in the body, disruption of some organs and systems, which can provoke a number of even more serious complications.

The situation can aggravate various injuries, osteochondrosis, metabolic disorders, blood diseases, age-related changes in blood vessels, chronic intoxication, etc.

[3], [4], [5], [6], [7], [8], [9]

Symptoms of hypertensive angiopathy

The initial stage of development of hypertensive angiopathy may not be accompanied by any complaints. Discomfort appears somewhat later, when the patient notes the fall of vision, the appearance of "flies", specks and stars in front of the eyes. An ophthalmologist on examination discovers the narrowing of the retina arteries, their quirkiness, the presence of the corkscrew (Gvista) symptom, the change in the vascular lumen. In more severe stages, there is a lack of blood in the vessels, hemorrhages, blood clots in the form of extravasates.

The disease begins with the appearance of changes in the smallest arterial vessels in the distal parts of the retina and along the circumference of the yellow spot. Gradually, the pathology progresses, there are signs of sclerosing vessels, their lumen becomes uneven, convoluted with periodic desolations in the arterioles. To the above violations are signs of retinal damage: deterioration and blurring of vision, hemorrhages in various places of the eyeball.

Initial changes in hypertensive angiopathy still have the ability to eliminate, more advanced cases are much more difficult to treat.

Angiopathy according to the hypertonic type

What it is necessary to remember about the development of angiopathy according to the hypertonic type:

• this type of angiopathy is solely a consequence of prolonged high blood pressure. Hence - the expanded venous vessels of the fundus, small hemorrhages on the eyeball, neuro-regulatory dysfunction;
• if you do not take any action, the disease will trigger a number of changes in the retina. In particular, the areas of the retina grow turbid, which can be corrected by timely and correct treatment of hypertension;
• even in the initial stages of angiopathy, the disease can be detected by careful examination of the eye fundus area. When the patient still does not feel signs of visual impairment, the method of fluorescent angiography makes it possible to determine a fairly clear picture of the smallest vascular changes.

Hypertensive angiopathy of the vessels of the retina can be accompanied by damage to the vessels of the urinary system, heart, central nervous system. Sometimes the vessels do not have time to adapt to excessive pressure, they become brittle, which is the cause of hemorrhages in the brain and heart tissues. Because of changes in blood circulation in the brain, there are neurological disorders: irritability, suspiciousness, emotional imbalance. Memory worsens, concentration of attention, weakening of mental activity. In the absence of treatment, the disorders become irreversible.

[10], [11], [12], [13]

Hypertensive angiopathy of both eyes

Since hypertension, as a rule, affects the vessels throughout the body, hypertensive angiopathy develops simultaneously in both eyes.

The disease progresses gradually, passing through certain stages in its development. Disorders of vascular function are manifested in the narrowing of the arterial lumen and the expansion of the venous: this contributes to the violation of blood circulation. As a rule, such changes are noticeable only after careful examination of the fundus.

Disorder of the vascular function gradually develops into a change in the arterial wall, which becomes thicker. Elements of connective tissue appear in it. Because of the compaction of the walls, the blood circulation in the retina is disrupted mainly by the deterioration of the blood outflow.

Over time, microcirculation undergoes more and more serious disorders: there is the appearance of edematic retina, or small hemorrhages. When examining the fundus, condensed arterial vessels, as well as enlarged and sinuous venous vessels, are found.

Hypertensive angiopathy of the retina is a disorder of the retina due to extreme violations of blood circulation in it. The ocular bottom is covered with zones of hemorrhages (microinfarctions) and lipid accumulations in the tissue layer of the retina. Edema of the retina is aggravated.

In addition, the development of complications, which are provoked by a disorder of the circulation and changes in the walls of the vessels, is not excluded. Such complications include, first of all, a violation of the patency of the central artery of the retina and its branches. The venous vessels also suffer: a blockage of the main vein of the retina and its branches is possible. Violated trophic (nutrition) of the optic nerve. All complications are serious enough and can lead to a sudden and often irreversible impairment of visual function.

Diagnosis of hypertensive angiopathy

For successful and adequate treatment of hypertensive angiopathy, a qualified diagnosis is necessary. Diagnostic methods are selected and assigned by an ophthalmologist.

A common method of diagnosis is ophthalmoscopy, which includes the determination of the number of vessels in red and red light. The essence of this method is that the vessels (especially the arterial ones) on the fundus in the red spectrum are not viewed as well as in normal or red light. Arterial vessels, narrowed by hypertensive angiopathy, are seen worse than normal vessels, and completely disappear from sight when viewed in red light. The use of this method can allow an objective assessment of the state of blood vessels on the fundus.

You may need ultrasound of blood vessels, which provides a complete picture of blood circulation. Doppler scan allows you to evaluate changes in vascular walls. Sometimes an X-ray examination using a contrast medium is used to observe the patency of the vascular lumen, or MRI.

In recent years, the incidence of angiopathy has also increased in childhood. It is worth noting that in children, the disease should be detected as quickly as possible, since the circulatory disorders in the retina in the child are much more rapid. Signs of angiopathy can be detected by a close examination of the capillary mesh of the fundus.

[14], [15], [16], [17], [18]

Treatment of hypertensive angiopathy

The main medical measures for hypertensive angiopathy should be aimed at eliminating hypertension and stabilizing blood pressure. For this, the doctor prescribes drugs that lower blood pressure.

There are several groups of drugs that can affect high blood pressure:

• β-blockers - slow down the frequency of cardiac contractions, reduce distal vascular resistance. These agents include atenolol, lokren, and others;
• drugs that inhibit the angiotensin-converting enzyme - inhibit the production of renin in the body, which causes a rise in pressure. This means prestarium, hood, spirapril, etc .;
• drugs that block calcium channels in the vascular walls and increase vascular clearance (corinfar, felodipine, etc.);
• diuretic drugs that remove excess fluid from the body (hydrochlorothiazide, clopamide, etc.).

In addition to antihypertensive drugs, it is possible to use the following medicines:

• drugs that dilate blood vessels. They are used to improve blood circulation, both in capillaries and in larger vessels. Such means include trental, vazonite and others;
• drugs that improve blood circulation (solkoseril, pentoksifillin, actovegin);
• means that reduce the permeability of the walls of blood vessels (parmidin, ginkgo, etc.);
• blood thinners (aspirin, cardiomagnesium, dipyridamole);
• vitamin complexes, which include ascorbic and nicotinic acid, vitamins of group B;
• means for improving metabolic processes in tissues (ATP, cocarboxylase).

The doctor will recommend the patient to revise his diet and lifestyle: quit smoking, stop drinking alcohol, limit salt intake, and establish a psycho-emotional balance.

Prevention of hypertensive angiopathy

Prevention of hypertensive angiopathy is directly related to the stabilization of blood pressure. In particular, this applies to people with a hereditary predisposition to hypertension. A healthy lifestyle and periodic examinations with a cardiologist will help prevent the development of hypertensive disease.

To think about the prevention of hypertensive angiopathy should be all those who periodically and the more constantly experiencing an increase in blood pressure.

First, it is necessary to pay attention to the habitual way of life and, perhaps, to change it a little. It is necessary to bring in the daily routine of the day physical exercises, consisting of morning exercises and periodic warm-up exercises. Bicycle riding, walking and easy jogging are welcome.

Secondly, it is necessary to establish a balanced diet consisting of vegetables, herbs, berries and fruits, as well as cereals, low-fat meat and seafood. It is necessary to reduce the amount of salt, exclude alcohol and low-alcohol beverages. If there is excess weight, then it is important to take action to normalize it.

Thirdly, you need to monitor your emotional state, avoid and resist stress, do not overwork, sleep well, find time, both for work and for a good rest.

It has been scientifically proven that happy people rarely get hypertension and angiopathy, even if they have a hereditary predisposition. Therefore, the best prevention can be, in addition to a healthy lifestyle, moral well-being in the family and the presence of a favorite work.

Prognosis of hypertensive angiopathy

The prognosis of hypertensive angiopathy largely depends on the timely treatment and stabilization of blood pressure.

Against the backdrop of a prolonged existing high blood pressure without appropriate therapy, very serious complications can subsequently occur, leading not only to visual impairment, but also to complete blindness.

If therapeutic measures are started on time, vascular changes can be reversible and completely go away after the stabilization of blood pressure.

Hypertensive angiopathy requires compulsory treatment. Moreover, the constant signs of high blood pressure - this is a sufficient reason for treatment not only to a specialist cardiologist, but also to an ophthalmologist who will conduct a preventive examination and assess the condition of your blood vessels.