Hypertensive angiopathy

Hypertensive angiopathy is a consequence of long-term hypertension, usually stage I-II B.

The disease is characterized by dilation of the venous vessels of the fundus, changes in their tortuosity, the appearance of branching of the vascular bed, disproportionate lumen of the arteries, and the possibility of pinpoint hemorrhages. When such a disease is detected, emergency treatment is required, otherwise the patient may partially or completely lose his sight.

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Causes of hypertensive angiopathy

Hypertensive angiopathy occurs as a result of prolonged hypertension – chronically high blood pressure. Blood pressure is considered high if its systolic readings are equal to or exceed 140 mm Hg, and diastolic readings are equal to or exceed 90 mm Hg.

There can be many reasons for this condition, and, first of all, it is a hereditary predisposition, excess body weight, bad habits, lack of physical activity, consumption of excessively salty foods, and a lack of magnesium and potassium salts in the body.

Sometimes blood pressure increases as a result of other diseases and pathological conditions: these are disorders of endocrine function, pathologies of the central nervous system, etc.

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

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

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Symptoms of hypertensive angiopathy

The initial stage of hypertensive angiopathy may not be accompanied by any complaints. Discomfort appears somewhat later, when the patient notes a decline in vision, the appearance of "flies", spots and stars before the eyes. During examination, the ophthalmologist discovers narrowing of the retinal arteries, their dodginess, the presence of a corkscrew symptom (Guist), and a change in the vascular lumen. In more severe stages, there is obstruction of blood flow through the vessels, hemorrhages, and blood accumulations in the form of extravasates.

The disease begins with changes in the smallest arterial vessels in the distal parts of the retina and around the macula lutea. Gradually, the pathology progresses, signs of vascular sclerosis appear, their lumen becomes uneven, tortuous with periodic desolation in the arterioles. Signs of retinal damage are added to the above-mentioned disorders: deterioration and blurring of vision, hemorrhages in various places of the eyeball.

Initial changes in hypertensive angiopathy can still be eliminated, but more advanced cases are much more difficult to treat.

Angiopathy of the hypertensive type

What you need to remember about the development of angiopathy of the hypertensive type:

• This type of angiopathy is exclusively a consequence of long-term high blood pressure. Hence - dilated venous vessels of the fundus, small hemorrhages on the eyeball, neuroregulatory dysfunction;
• if no action is taken, the disease will cause a number of changes in the retina. In particular, areas of the retina become cloudy, which can be corrected by timely and proper treatment of hypertension;
• Even in the initial stages of angiopathy, the disease can be detected by careful examination of the fundus. When the patient does not yet feel signs of vision deterioration, the fluorescent angiography method allows us to determine a fairly clear picture of the smallest vascular changes.

Hypertensive angiopathy of the retinal vessels may be accompanied by damage to the vessels of the urinary system, heart, and central nervous system. Sometimes the vessels do not have time to adapt to the excess pressure, they become brittle, which causes hemorrhages in the tissues of the brain and heart. Due to changes in blood circulation in the brain, neurological disorders are observed: irritability, suspiciousness, emotional instability are noted. Memory and concentration deteriorate, mental activity is weakened. Without treatment, the disorders become irreversible.

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Hypertensive angiopathy of both eyes

Since hypertension usually affects blood vessels throughout the body, hypertensive angiopathy develops simultaneously in both eyes.

The disease progresses gradually, passing through certain stages in its development. Vascular dysfunctions manifest themselves in the narrowing of the arterial lumen and the expansion of the venous lumen: this contributes to the disruption of blood circulation. As a rule, such changes are noticeable only with a careful examination of the fundus.

The disorder of vascular function gradually develops into a change in the arterial wall, which becomes thicker. Elements of connective tissue appear in it. Due to the thickening of the walls, blood circulation in the retina is disrupted mainly due to the deterioration of blood outflow.

Over time, microcirculation undergoes more and more disturbances: the appearance of edematous areas of the retina or small hemorrhages is observed. When examining the fundus, thickened narrowed arterial vessels are found, as well as dilated and tortuous venous vessels.

Hypertensive angiopathy of the retina is a disorder of the retina due to extreme disturbances in blood circulation in it. The fundus is covered with areas of hemorrhage (microinfarctions) and lipid accumulations in the tissue layer of the retina. Retinal edema worsens.

In addition, complications caused by circulatory disorders and changes in the vessel walls cannot be ruled out. Such complications include, first of all, obstruction of the central retinal artery and its branches. Venous vessels are also affected: blockage of the main retinal vein and its branches is possible. The trophism (nutrition) of the optic nerve is disrupted. All complications are quite serious and can lead to sudden and often irreversible deterioration of visual function.

Diagnosis of hypertensive angiopathy

For successful and adequate treatment of hypertensive angiopathy, qualified diagnostics are required. Diagnostic methods are selected and prescribed by an ophthalmologist.

A common diagnostic method is ophthalmochromoscopy, which includes determining the number of vessels in red and red-free light. The essence of this method is that the vessels (especially arterial) in the fundus are not as well visible in the red spectrum as in normal or red-free light. Arterial vessels narrowed by hypertensive angiopathy are less visible than normal vessels and disappear completely from view when examined in red light. Using this method can allow an objective assessment of the condition of the blood vessels in the fundus.

An ultrasound of the vessels may be required, providing a complete picture of the blood circulation. Doppler scanning allows you to evaluate changes in the vascular walls. Sometimes an X-ray examination is prescribed using a contrast agent to observe the patency of the vascular lumen, or MRI.

In recent years, cases of angiopathy in childhood have become more frequent. It is worth noting that in children, the disease must be detected as quickly as possible, since circulatory disorders in the retina in a child occur much more rapidly. Signs of angiopathy can be detected by careful examination of the capillary network of the fundus.

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Treatment of hypertensive angiopathy

The main treatment 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 known to have an effect on high blood pressure:

• β-blockers – slow the heart rate, reduce distal vascular resistance. Such drugs include atenolol, lokren, etc.;
• drugs that inhibit angiotensin-converting enzyme - inhibit the production of renin in the body, which causes an increase in pressure. These are prestarium, capoten, spirapril, etc.;
• agents that block calcium channels in the vascular walls and increase vascular lumen (corinfar, felodipine, etc.);
• diuretics that remove excess fluid from the body (hydrochlorothiazide, clopamide, etc.).

In addition to antihypertensive drugs, the following medications may be used:

• drugs that dilate blood vessels. They are used to improve blood circulation, both in capillaries and in larger vessels. Such drugs include Trental, Vasonite, etc.;
• drugs that improve blood circulation (solcoseryl, pentoxifylline, actovegin);
• agents that reduce the permeability of the vascular wall (parmidine, ginkgo, etc.);
• blood thinners (aspirin, cardiomagnyl, dipyridamole);
• vitamin complexes including ascorbic and nicotinic acid, B vitamins;
• agents for improving metabolic processes in tissues (ATP, cocarboxylase).

The doctor will definitely recommend that the patient review their diet and lifestyle: quit smoking, stop drinking alcohol, limit salt intake, and improve psycho-emotional balance.

Prevention of hypertensive angiopathy

Prevention of hypertensive angiopathy is directly related to stabilization of blood pressure. This is especially true for people with a hereditary predisposition to hypertension. A healthy lifestyle and regular examinations by a cardiologist will help prevent the development of hypertension.

Anyone who periodically and especially constantly experiences high blood pressure should think about preventing hypertensive angiopathy.

First, you need to pay attention to your usual lifestyle and perhaps change it a little. You should include physical activity in your daily routine, consisting of morning exercises and periodic warm-up exercises. Cycling, walking and light jogging are welcome.

Secondly, it is necessary to establish a balanced diet consisting of vegetables, greens, berries and fruits, as well as cereals, lean meat and seafood. It is imperative to reduce the amount of salt, exclude alcoholic and low-alcohol drinks. If there is excess weight, it is important to take steps to normalize it.

Thirdly, you need to monitor your emotional state, avoid and resist stress, not overwork yourself, get enough sleep, find time for both work and proper rest.

It has been scientifically proven that happy people rarely suffer from hypertension and angiopathy, even if they have a hereditary predisposition. Therefore, the best prevention may be, in addition to a healthy lifestyle, moral well-being in the family and having a favorite job.

Prognosis of hypertensive angiopathy

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

Against the background of long-term high blood pressure without appropriate therapy, very serious complications may subsequently arise, leading not only to deterioration of vision, but sometimes to complete blindness.

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

Hypertensive angiopathy requires mandatory treatment. Moreover, constant signs of high blood pressure are a sufficient reason to contact not only a cardiologist, but also an ophthalmologist who will conduct a preventive examination and assess the condition of your blood vessels.