Hypertension

 

What is hypertension?

Hypertension, most commonly referred to as "high blood pressure", is a medical condition in which the blood pressure is chronically elevated.

Hypertension leads to many changes in the blood vessels of the body. These same changes occur in the blood vessels of the eyes in many ways. They can cause many problems, including:

  • Hypertensive retinopathy

  • Macroaneurysms

  • Branch retinal vein occlusion (BRVO) and vitreous hemorrhage

  • Optic nerve involvement (Optic neuropathy)

  • Involvement of the nerves supplying the eye muscles, leading to temporary paralysis or weakness of these muscles


What are the symptoms of hypertension and hypertension affecting the eye?
Symptoms of hypertension include shortness of breath, early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors

Many of the eye conditions caused by hypertension may not have any symptoms in the initial stages. Therefore, it is important to have a periodic eye exam to detect them. Branch retinal vein occlusion (BRVO) may lead to a blurring of vision, especially for fine work. A vitreous hemorrhage may lead to a more severe loss of vision associated with a shower of red floaters. Optic neuropathy may also lead to a loss of vision, which is painless and not associated with any floaters. Paralysis or weakness of the muscles of the eye leads to restriction of movement of the eye and double vision.

What causes hypertension?

  • Smoking

  • Being overweight or obese

  • Lack of physical activity

  • Too much salt in the diet

  • Too much alcohol consumption (more than 1 to 2 drinks per day)

  • Stress

  • Older age

  • Family history of high blood pressure

  • Chronic kidney disease

  • Adrenal and thyroid disorders

  • Sleep apnea

 

Who develops hypertension?

​Although anyone can get hypertension with enough risk factors, there are certain people that are more prone to developing hypertension. They include: 

  • People with family members who have high blood pressure

  • Smokers

  • African-Americans

  • Pregnant women

  • Women who take birth control pills

  • People over the age of 35

  • People who are overweight or obese

  • People who are not active

  • People who drink alcohol excessively

  • People who eat too many fatty foods or foods with too much salt

  • People who have sleep apnea

Patients with hypertensive eye problems tend to have higher than normal blood pressures for longer periods of time. Any concurrent condition like diabetes can increase the chance of having hypertensive eye problems. 

 

How is hypertension diagnosed?

Hypertension is diagnosed by measuring a patient's blood pressure. The stages of blood pressure according to the American Heart Association is as follows: 

We rarly rely on one reading alone. Usually 2–3 office visits at 1–4-week intervals (depending on the BP level) are required to confirm the diagnosis of hypertension. The diagnosis might be made on a single visit, if BP is ≥180/110 mm Hg and there is evidence of cardiovascular disease (CVD).

The eye is the only organ of the body where one can observe the blood vessels directly. By examining your eyes, our optometrists may observe the changes in blood vessels caused by hypertension. This also provides information about the severity of the disease elsewhere in the body. Moreover, presence of swelling of the disc (grade 4 hypertensive retinopathy) is an indicator of a very severe, life threatening rise in blood pressure, which warrants emergency treatment. We measure the blood pressure at every comprehensive eye examination and look at the retinas to rule out any problems. 

What is the treatment for hypertension and eye related changes?

Treatment for hypertension includes: 

  • Weight loss

  • Increased physical activity

  • Stress reduction

  • Diet, reducing salt intake, reducing alcohol consumption, eating less fat and more fruits and vegetables, following a DASH diet

  • Medications
     

For minor eye related changes, the major treatment is controlling the hypertension. Usually ifthe hypeertension decreased, so do the problems in the eye. When more severe ocular changes are present, laser, eye injections of medications, and other surgical procedures may be necessary.
 

What is the prognosis for hypertension? 

When caught soon enough and protocols set forth by both our optometrist and your primary care physician are followed, the prognosis is good. If treatment is not followed and regular examinations are not being performed, blindness is a possible consequence. 

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