RETINOPATIA HIPERTENSIVA

RETINA Y MACULA  The retinopathy hipertensiva is the illness produced by the degeneration of the retina owing to the arterial hypertension (HTA).

The arterial hypertension
The arterial hypertension (HTA) is the factor of cardiovascular modifiable risk more hurtful, since the increase of the arterial pressure increases the probability of cardiac illnesses, neurológicas and even of mortality. The arterial hypertension affects to the arteries of several organs of the body, acting silently during long before the harm in the organs was clinically apparent.
It considers that a person presents arterial hypertension when the arterial pressure sistólica is equal or upper to 140 mmHg, and the arterial pressure diastólica is equal or upper to 90 mmHg. In people diabéticas, with vascular or renal illness, considers that there is arterial hypertension when the pressure surpasses the 130/80 mmHg.
The retinopathy hipertensiva
The retinopathy hipertensIva is the set of alterations that take place in the retina caused by the arterial hypertension. These changes can observe in the examination of the fund of eye that makes by means of the ophthalmoscope.
The retina sees altered by injuries that are consequence of the hypertension, although other factors, like the arteriosclerosis or the age advanced, influence in the development of the retinopathy hipertensiva.
The examination of the fund of eye in the patients hipertensivos is fundamental, since the changes that appreciate in the retina allow to estimate the gravity of the changes produced in other organs to consequence of the hypertension and establish in this way a prognosis of the illness. Still like this, the absence of signs of arterial hypertension in the background examination of eye no descarta the existence of arterial hypertension neither of alterations in the circulation in other parts of the organism.
 
Which symptoms produces the retinopathy hipertensiva?
Retinopathy hipertensiva chronic. The main part of the people with this type of problem remain without symptoms during long and are used to to be diagnosed thanks to the background examinations of eye that make like part of the control of the arterial hypertension. At the bottom of eye can appreciate in these cases a decrease of the thickness of the glasses, some crosses arterio-venous pathological and dilatations saculares in the wall of the glasses. Besides, this type of hypertension augments the risk that they produce vascular occlusions, being able to affect then the vision. In the patients with hypertension of long evolution or severe, can appear blurred vision or decrease of the visual acuteness and in some cases can exist a significant loss of the vision, especially in those cases associated to other pathologies, like diabetes or arteriosclerosis.
Retinopathy hipertensiva acute. Also it knows like malignant retinopathy or accelerated. This type of retinopathy occurs especially in patients with hypertension associated to illnesses like eclampsia or preeclampsia, pheocromocytoma, etc. In these cases the vision can affect of way more important. It presents in situations in which the increase of the arterial pressure is brusque. It characterises for presenting blurred vision, that is used to to be transitory and normalises when reestablishing the normal values of pressure, being able to be accompanied of headache. At the bottom of eye observes a decrease generalised of the calibrate of the glasses. In the gravest cases can appreciate bleedings, exudates and edema of papilla.
 
To what owes the loss of vision in the retinopathy hipertensiva?
The increase of the arterial tension alters the blood vessels. In the retina exist crowd of arteries and veins that visit his surface. When the arterial tension augments, the glasses and the tissues that surround them suffer alterations: increase of permeability, that causes the start of liquid and substances of the plasma to the retina. Some glasses suffer an important contraction, diminishing the blood flow to some regions of the retina that remain damaged by the fault of blood watering. Also they can produce bleedings owed to the harm suffered by the glasses. The start of pertinent liquid of these can give place, finally, to edema of the retina.
In the gravest cases, can affect also the coroides (layer that surrounds to the retina),giving place to coroidopatía hipertensiva. When the illness is very advanced finishes affecting to the optical nerve. It designates papiledema the accumulation of liquid in the initial tract of the optical nerve (called optical papilla). Both are signs advanced of hypertension and can accompany of significant alterations of the vision.

Factors of risk of the retinopathy hipertensiva
•Badly control of the arterial pressure crónicamente high.
•Diabetes mellitus.
•Consumption of tobacco.
•Pregnancy.
•Tall levels of cholesterol and triglycerides.
•Be main of 50 years.
•Diverse genetic factors.

How it diagnoses the retinopathy hipertensiva?
The main method to diagnose the retinopathy hipertensiva is by means of the studio of the fund of eye, that consists in the analysis of the retina and his glasses by means of an ophthalmoscope. It is a simple and painless proof that makes in few minutes.
Besides, nowadays it is possible to film or photograph the fund of eye and conserve an image to compare it with other future to follow the evolution of the patient.
The angiografía with fluorescein allows the register of the image of the fund of eye after the injection of a contrast that distributes through the blood circulation. This technical can result of utility to value the gravity of the illness, especially in those cases in that they exist pathologies associated like the retinopathy diabética.

Treatment
It does not exist a specific treatment for the retinopathy hipertensiva. The treatment consists in controlling adequately the arterial pressure. By this motive, in addition to following some habits of healthy life (control of weight, decrease of the salt in the lunches, moderate physical exercise and regulate...) And the administration of drugs antihipertensivos, is importantísimo measure regularly the arterial tension, with the end to diagnose the arterial hypertension and follow the suitable treatment. Maintaining the levels of arterial tension inside the normal limits will be able to avert the harm that the arterial hypertension produces in the distinct organs and in our eyes.
In the case of the retinopathy hipertensiva acute is in front of a situation of urgency, whose treatment makes in the hospitable field and goes oriented to an exhaustive control of the figures of arterial tension with treatments much more specific.
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