Early Stage of Hypertensive Retinopathy; Is It Really Important?

OBJECTIVE: To investigate the relationship between early stage hypertensive retinopathy (HTRP)
and endothelial dysfunction (ED) in atherogenesis.

MATERIAL and METHODS:Atotal 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).