Challenges to establish causality between hypertensive retinopathy and Grade III hypertension: A retrospective cohort analysis

摘要

Background: Accelerated/Malignant hypertension (A/MH) is ahypertensive emergency, clinically defined by the European societyof Hypertension/European society of cardiology (ESH/ESC) asthe presence of very high BP associated with target organ damage(TOD) [retina, kidney, heart or brain]. The 5 years survival ratereported after the diagnosis of A/MH has improved significantlywhich could be due to earlier diagnosis, lower BP targets andavailability of new classes of antihypertensive agents.Objective: To estimate the incidence of A/MH and evaluate itsprognosis and management.Methods: A retrospective cohort analysis was carried out at our2500 bedded tertiary care teaching hospital on patients admittedwith essential HTN (during 2008 - 2012) with ICD e 10 (I.10) codingwith no comorbidities with age 40 were considered for the study.Results: Of the 305 in-patients diagnosed with essential HTN, 17(5.8%) were found to have Grade III HTN (ESH/ESC 2013) whichwere documented as A/MH. Male predominance was found to behigher with 53% with a mean age for 58 years (±10 SD) and meanBMI of 23.8 (±4.7 SD). TOD identified in 17 patients were: 2 patients(12%) ophthalmic, 9 (53%) left ventricular failure and none reportedin 6 (35%). All patients except one were treated withamlodipine (88%) either as monotherapy or with other classesincluding ARBs, ACEi, diuretics, beta blockers or clonidine. Readmissionswere reported in 5 (29%) with only 1(6%) being diagnosedwith CAD on the first readmission.Conclusion: Going by the standard criteria for diagnosing A/MHwhere BP is 180/ 110, through our study we could safely concludethat 14 patients (83%) were either not reported with visualchanges or not being referred for ophthalmic evaluation. Thiscould also.