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Erken Evre Hipertansif Retinopati; Gerçekten Önemli mi?

Early Stage of Hypertensive Retinopathy; Is It Really Important?

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2014
DOI: 
10.5262/tndt.2014.1003.11

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
OBJECTIVE: To investigate the relationship between early stage hypertensive retinopathy (HTRP) and endothelial dysfunction (ED) in atherogenesis. MATERIAL and METHODS: A total of 99 subjects consisting of 73 patients diagnosed with Essential Hypertension (HT) and 26 healthy subjects were included to the study. Flow mediated dilatation (FMD) was performed to detect ED. Asymmetric dimethylarginine-ADMA was measured as a marker of ED and the hsCRP and sTWEAK levels were measured for microvascular inflammation. All patients were screened for retinopathy. RESULTS: The mean blood pressure of the hypertensive patients and the control subjects was 140.1±13.7/86.1±10.7 and 107.12±10.0/65.38±10.2 respectively. HTRP was positive in 60.3% (n=44) and negative in 39.7% (n=29) of the patients with hypertension. There was grade 1 retinopathy in 52.1% and grade 2 retinopathy in 8.2% of hypertensive patients. The hsCRP, sTWEAK and ADMA levels were significantly higher in hypertensive patients than in the control group (respectively, p=0,011, p=0,001, p=0,001). FMD levels were lower in the hypertensive group, as expected. FMD levels were lower in the retinopathy group when the hypertensive group with and without retinopathy and the control group compared. hsCRP, sTWEAK and ADMA levels were significantly higher in subjects with retinopathy. hsCRP, sTWEAK and ADMA levels were also significantly higher in subjects with retinopathy (p=0.039, p=0.001, p=0.001). CONCLUSION: ED is thought to play a role in HT etiology and is also important in the development of HT complications. It would be appropriate to evaluate hypertensive patients more carefully and perform the necessary laboratory tests to detect ED so that the proper treatment can be started (ACEI, exercise, lifestyle changes).
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Abstract (Original Language): 
AMAÇ: Erken dönem hipertansif retinopati ile aterogenez sürecinde oldukça önemli bir yer tutan endotel disfonksiyonu (ED) ve vasküler mikroinflamasyon ilişkisini araştırmak. GEREÇ ve YÖNTEMLER: Esansiyel Hipertansiyon tanısı ile takip edilen hastalar (n=73) ile sağlıklı olgulardan(n=26) oluşan toplam 99 kişi alındı. Hastalarda ED saptamak için Akım Aracılı Genişleme (flow mediated dilatation-FMD) işlemleri yapıldı. ED belirteci olarak Asimetrik dimetilarginin-ADMA ile vasküler mikroinflamasyon belirteci olarak sTWEAK ile hsCRP düzeyleri çalışıldı. Hastaların retinopati taraması yapıldı. BULGULAR: Hipertansif hastalar ile kontrol grubunun arteriyel kan basıncı (AKB) ortalaması sırasıyla (140,1±13,7/86,1±10,7) (107,12±10,0/65,38±10,2) saptandı. Hipertansif hastaların %60,3(n:44) ünde HTRP var iken %39,7(n:29) sinde yoktu. Retinopati olanların %52,1 i evre 1 iken %8,2 si evre 2 olarak saptandı. Hipertansif hastalar kontrol grubuyla karşılaştırıldığında hsCRP, sTWEAK ve ADMA (sırasıyla p=0,011, p=0,001, p=0,001) düzeyleri anlamlı şekilde yüksek saptandı. FMD ölçümleri beklendiği gibi hipertansif grupta daha düşük olarak ölçüldü. Hipertansif hastalarda retinopati olan ve olmayan hastalar ile kontrol grubu arasında yapılan karşılaştırmada FMD oranlarının anlamlı şekilde retinopatili grupta düşük olduğu görüldü(p=0,033). Yine hsCRP, sTWEAK ve ADMA düzeyleri retinopatili olgularda anlamlı şekilde yüksek bulundu (p=0,039, p=0,001, p=0,001). SONUÇ: ED, HT etiyolojisinde suçlandığı gibi HT a bağlı komplikasyonların ortaya çıkmasında da önemlidir. ED’nin hipertansif hastalarda erken dönemde tespiti için gerekli laboratuvar tetkiklerinin yapılması ve bu hastalarda ED’yi düzeltici tedavi seçeneklerinin (ACEİ, egzersiz, yaşam tarzı değişkliği vb.) daha dikkatli değerlendirilmesi uygun olacaktır.
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