ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2018-4-470-475ophthalmology-774Research ArticleОФТАЛЬМОФАРМАКОЛОГИЯPHARMACOLOGYСовременные аспекты гипертонической ангиоретинопатииModern Aspects of Hypertensive AngioretinopathyМошетоваЛ. К.MoshetovaL. K.

доктор медицинских наук, профессор, академик РАНул. Баррикадная, 2/1, Москва, 123242, Российская Федерация

MD, professor, Academician of the Russian Academy of SciencesBarrikadnaya str., 2/1, Moscow, 125993, Russia

ВоробьеваИ. В.VorobyevaI. V.

кандидат медицинских наук, доцентул. Баррикадная, 2/1, Москва, 123242, Российская Федерация

PhD, Assistant ProfessorBarrikadnaya str., 2/1, Moscow, 125993, Russia

irina.docent2000@mail.ruДгебуадзеА.DgebuadzeA.

аспирант кафедры офтальмологииул. Баррикадная, 2/1, Москва, 123242, Российская Федерация

postgraduateBarrikadnaya str., 2/1, Moscow, 125993, Russia

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования»РоссияRussian Medical Academy of Postgraduate EducationRussian Federation201808012019154470475Copyright © Мошетова Л.К., Воробьева И.В., Дгебуадзе А., 20192019Мошетова Л.К., Воробьева И.В., Дгебуадзе А.Moshetova L.K., Vorobyeva I.V., Dgebuadze A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/774

Обзор литературы посвящен современным проблемам гипертонической ретинопатии с артериальной гипертензией, а также гипертонической ретинопатии при сочетанных заболеваниях. Проанализированы последние мировые исследования. Особенное внимание уделяется клинической картине заболевания на современном этапе с анализом артериовенозного соотношения, отека диска зрительного нерва (при высоких цифрах артериального давления) с помощью автоматизированной системы, векторного анализа, с предложением новой артериовенозной классификации, с введением новой медицинской технологии, называемой веб-интеграцией (Wivern). Особую роль в обзоре занимают современные представления о патогенезе гипертонической ретинопатии, а именно, о соотношении проангиогенных и антиангиогенных факторов, роли воспаления (С-реактивного белка), роли эндотелина-1, эндостатина, интерлейкина-8 (IL-8) и основного фактора роста фибробластов (bFGF), ангиогенина и мочевой кислоты. Отражена особая значимость фундусрегистрации с помощью новейшего оборудования при высоких цифрах артериального давления у пациентов с гипертонической ретинопатией. По данным Всемирной организации здравоохранения (ВОЗ), смертность от сердечно-сосудистых заболеваний составляет 31 %. Гипертензия является основным фактором риска ишемической болезни сердца, инфаркта миокарда, сердечной недостаточности, инсульта, заболевания почек и ранней смерти. Освещены вопросы глазного кровотока при гипертонической ангиоретинопатии у пациентов с артериальной гипертензией (АГ). Гипертоническая ретинопатия (ГР) — это заболевание сетчатки, которое вызвано длительным повышением артериального давления (АД) и приводит к снижению зрения. Проанализированы данные патофизиологии: артериальная гипертензия (АГ) приводит к утолщению внутренней оболочки сосудов (интимы), средней оболочки (медии) — гиперплазии мышечной ткани — с последующей гиалиновой дегенерацией с развитием склеротических изменений. Освещены вопросы современной диагностики с оценкой морфологического состояния сетчатки с помощью ОКТ, регистрацией состояния глазного дна с использованием фундускамер, патогенетические аспекты. Приведены сведения о возможном предупреждении развития более тяжелых форм гипертонической ретинопатии, о выявлении наиболее значимых показателей для ранней диагностики гипертонической ангиоретинопатии. 

This literature review is devoted to modern problems of hypertensive retinopathy with arterial hypertension, as well as hypertensive retinopathy in combination diseases. The latest world studies were analyzed. Particular attention is paid to the clinical disease characteristics at the present stage with the analysis of the arterio-venous ratio, optic nerve edema (with high blood pressure figures) using an automated system, vector analysis, suggesting a new arteriovenous classification, called Web Integration (Wivern). The modern pathogenesis of hypertensive retinopathy, namely the ratio of proangiogenic and anti-angiogenic factors, the role of inflammation (C-reactive protein), the role of endothelin-1, endostatin, interleukin-8 (IL-8), and the main fibroblast growth factor (bFGF ), angiogenin and uric acid. The special importance of fundus registration is reflected with the help of the newest equipment at high figures of arterial pressure in patients with hypertensive retinopathy. It is known that according to the World Health Organization (WHO), mortality rate from cardiovascular diseases is 31 %. Hypertension is the main risk factor for coronary heart disease, myocardial infarction, heart failure, stroke, kidney disease and early death. Questions of eye blood flow in hypertensive angioretinopathy in patients with arterial hypertension (AH) are covered. Hypertensive retinopathy (HR) is a retinal disease that is caused by a prolonged increase blood pressure (BP) and leads to a decrease in vision. The data of pathophysiology are analyzed (arterial hypertension (AH) leads to thickening of the vessels of the inner membrane (intima), to thickening of the medial membrane (media) — hyperplasia of the muscular tissue followed by hyaline degeneration with the development of sclerotic changes). The questions of modern diagnostics with retinal morphological status evaluation (OCT), detection of eye fundus condition with newest fundus camers, pathogenetic aspects are discussed. This review will help to prevent the development of more severe forms of hypertensive retinopathy. This information will allow us to identify the most significant indicators in the early diagnosis of hypertension angioretinopathy.

артериальная гипертензияретинопатияглазной кровотоккардиоваскулярный рискауторегуляторные механизмыаrterial hypertensionretinopathyocular blood flowcardiovascular riskautoregulatory mechanismsReferencesWorld Health Organization. A global brief on hypertension: silent killer, global public health crises (World Health Day 2013). Geneva: WHO, 2013.World Health Organization. A global brief on hypertension: silent killer, global public health crises (World Health Day 2013). Geneva: WHO, 2013.Chen X.L., Meng Y., Li J., She H.C., Zhao L., Zhang J., Peng Y., Shang K., Zhang Y.D., Gu X.P. Serum Uric Acid Concentration Is Associated With Hypertensive Retinophaty In Hypertensive Chinese Adults. BMC Ophthalmology. 2017;17:83. DOI: 10.1186/S12886-017-0470-YChen X.L., Meng Y., Li J., She H.C., Zhao L., Zhang J., Peng Y., Shang K., Zhang Y.D., Gu X.P. Serum Uric Acid Concentration Is Associated With Hypertensive Retinophaty In Hypertensive Chinese Adults. BMC Ophthalmology. 2017;17:83. DOI: 10.1186/S12886-017-0470-YRao V.R.R.M., Natarajaboopathy R., Kumar K.M.S., Grace V.M.R.J. Hypertensive Retinopathy — Prevalence, Risk Factors and Comorbids. Journal Evolution of Medical and Dental Sciences-Jemds. 2016;5:6872–6874. DOI: 10.14260/jemds/2016/1553Rao V.R.R.M., Natarajaboopathy R., Kumar K.M.S., Grace V.M.R.J. Hypertensive Retinopathy — Prevalence, Risk Factors and Comorbids. Journal Evolution of Medical and Dental Sciences-Jemds. 2016;5:6872–6874. DOI: 10.14260/jemds/2016/1553Akbar S., Akram M.U., Sharif M., Tariq A., Yasin U.U. Arteriovenous ratio and papilledema based hybrid decision support system for detection and grading of Hypertensive retinopathy. Computer Methods and Programs in Biomedicine. 2017;154:123–141. DOI: 10.1016/j.cmpb.2017.11.014Akbar S., Akram M.U., Sharif M., Tariq A., Yasin U.U. Arteriovenous ratio and papilledema based hybrid decision support system for detection and grading of Hypertensive retinopathy. Computer Methods and Programs in Biomedicine. 2017;154:123–141. DOI: 10.1016/j.cmpb.2017.11.014Triantafyllou A., Anyfanti P., Gavriilaki E., Zabulis X., Gkaliagkousi E., Petidis K., Triantafyllou G., Gkolias V., Pyrpasopoulou A., Douma S. Association Between Retinal Vessel Caliber and Arterial Stiffness in a Population Comprised of Normotensive To Early-Stage Hypertensive Individuals. American Journal of Hypertension. 2014;27:1472–1478. DOI: 10.1093/ajh/hpu074Triantafyllou A., Anyfanti P., Gavriilaki E., Zabulis X., Gkaliagkousi E., Petidis K., Triantafyllou G., Gkolias V., Pyrpasopoulou A., Douma S. Association Between Retinal Vessel Caliber and Arterial Stiffness in a Population Comprised of Normotensive To Early-Stage Hypertensive Individuals. American Journal of Hypertension. 2014;27:1472–1478. DOI: 10.1093/ajh/hpu074Guedri H., Ben Abdallah M., Echouchene F., Belmabrouk H. Novel Computerized Method for Measurement of Retinal Vessel Diameters. Biomedicines. 2017;5:12. DOI: 10.3390/Biomedicines5020012Guedri H., Ben Abdallah M., Echouchene F., Belmabrouk H. Novel Computerized Method for Measurement of Retinal Vessel Diameters. Biomedicines. 2017;5:12. DOI: 10.3390/Biomedicines5020012McDonald L., Lee G.R., deGooyer T.E., McDonald D., Canning P., Kelso E.J., McDermott B.J., Stitt A.W. Effects of an Endothelin Receptor Antagonist on a Model of Hypertensive Retinopaty. Ophthalmic Research. 2010;43:99–107. DOI: 10.1159/000247594McDonald L., Lee G.R., deGooyer T.E., McDonald D., Canning P., Kelso E.J., McDermott B.J., Stitt A.W. Effects of an Endothelin Receptor Antagonist on a Model of Hypertensive Retinopaty. Ophthalmic Research. 2010;43:99–107. DOI: 10.1159/000247594Kur J., Newman E.A., Chan-Ling T. Cellular and Physiological Mechanisms Underlying Blood Flow Regulation in the Retina and Choroid in Health and Disease. Progress in Retinal and Eye Research. 2012;31:377–406. DOI:10.1016/j.preteyeres.2012.04.004Kur J., Newman E.A., Chan-Ling T. Cellular and Physiological Mechanisms Underlying Blood Flow Regulation in the Retina and Choroid in Health and Disease. Progress in Retinal and Eye Research. 2012;31:377–406. DOI:10.1016/j.preteyeres.2012.04.004Akay F., Gundogan F.C., Yolcu U., Toyran S., Tunç E., Uzun S. Retinal Structural Changs in Systemic Arterial Hypertension: An OCT Study. European Journal of Ophthalmology. 2016;26:436–441. DOI: 10.5301/ejo.5000740Akay F., Gundogan F.C., Yolcu U., Toyran S., Tunç E., Uzun S. Retinal Structural Changs in Systemic Arterial Hypertension: An OCT Study. European Journal of Ophthalmology. 2016;26:436–441. DOI: 10.5301/ejo.5000740Киселева Т.Н., Ежов М.Б., Аджемян Н.А. Нарушение ретинальной циркуляции при артериальной гипертензии. Фарматека. 2014;20:14–18 [Kiseleva T.N., Ezhov M.V., Ajemyan N.A. Violation Of Retinal Circulation In Hypertension. Рharmathics = Farmateka. 2014;20:14–18 (In Russ.)].Киселева Т.Н., Ежов М.Б., Аджемян Н.А. Нарушение ретинальной циркуляции при артериальной гипертензии. Фарматека. 2014;20:14–18 [Kiseleva T.N., Ezhov M.V., Ajemyan N.A. Violation Of Retinal Circulation In Hypertension. Рharmathics = Farmateka. 2014;20:14–18 (In Russ.)].Flammer J., Konieczka K., Bruno R.M., Virdis A., Flammer A.J., Taddei S. The eye and the heart. European Heart Journal. 2013;34:1270–1278. DOI: 10.1093/eurheartj/eht023Flammer J., Konieczka K., Bruno R.M., Virdis A., Flammer A.J., Taddei S. The eye and the heart. European Heart Journal. 2013;34:1270–1278. DOI: 10.1093/eurheartj/eht023Bolivar J.J. Essential Hypertension: An Approach to Its Etiology and Neurogenic Pathophysiology. International Journal of Hypertension. 2013;3:547809. DOI: 10.1155/2013/547809Bolivar J.J. Essential Hypertension: An Approach to Its Etiology and Neurogenic Pathophysiology. International Journal of Hypertension. 2013;3:547809. DOI: 10.1155/2013/547809Chopra A., Sharma A., Singh S., Bahl V. Changing Perspectives in Classifications of Hypertensive Retinopathy. Journal of Dental and Medical Sciences (IOSR-JDMS). 2014;13(6):51–54.Chopra A., Sharma A., Singh S., Bahl V. Changing Perspectives in Classifications of Hypertensive Retinopathy. Journal of Dental and Medical Sciences (IOSR-JDMS). 2014;13(6):51–54.Marek-Trzonkowska N., Kwieczynska A., Reiwer-Gostomska M., Kolinski T., Molisz A., Siebert J. Arterial Hypertension Is Characterized by Imbalance of Pro-Angiogenic versus Anti-Angiogenic Factors. Plos One. 2015;10:e0126190. DOI: 10.1371/journal.pone.0126190Marek-Trzonkowska N., Kwieczynska A., Reiwer-Gostomska M., Kolinski T., Molisz A., Siebert J. Arterial Hypertension Is Characterized by Imbalance of Pro-Angiogenic versus Anti-Angiogenic Factors. Plos One. 2015;10:e0126190. DOI: 10.1371/journal.pone.0126190Zou B.J., Chen Y., Zhu C.Z., Chen Z.L., Zhang Z.Q. Supervised Vessels Classification Based on Feature Selection. Journal of Computer Science and Technology. 2017;32:1222–1230. DOI: 10.1007/s11390-017-1796-xZou B.J., Chen Y., Zhu C.Z., Chen Z.L., Zhang Z.Q. Supervised Vessels Classification Based on Feature Selection. Journal of Computer Science and Technology. 2017;32:1222–1230. DOI: 10.1007/s11390-017-1796-xKeith N.M., Wagener H.P., Barker N.W. Some different types of essential hypertension: their course and prognosis. The American Journal of the Medical Sciences. 1974;268(6):336–345.Keith N.M., Wagener H.P., Barker N.W. Some different types of essential hypertension: their course and prognosis. The American Journal of the Medical Sciences. 1974;268(6):336–345.Novo J., Rouco J., Barreira N., Ortega M., Penedo M.G., Campilho A. Wivern: a Web-Based System Enabling Computer-Aided Diagnosis and Interdisciplinary Expert Collaboration for Vascular Research. Journal of Medical and Biological Engineering. 2017;37:920–935. DOI: 10.1007/s40846-017-0256-yNovo J., Rouco J., Barreira N., Ortega M., Penedo M.G., Campilho A. Wivern: a Web-Based System Enabling Computer-Aided Diagnosis and Interdisciplinary Expert Collaboration for Vascular Research. Journal of Medical and Biological Engineering. 2017;37:920–935. DOI: 10.1007/s40846-017-0256-yRubin D.S., Matsumoto M.M., Moss H.E., Joslin C.E., Tung A., Roth S. Ischemic Optic Neuropathy in Cardiac Surgery Incidence and Risk Factors in the United States from the National Inpatient Sample 1998 to 2013. Anesthesiology. 2017;126:810–821. DOI: 10.1097/ALN.0000000000001533Rubin D.S., Matsumoto M.M., Moss H.E., Joslin C.E., Tung A., Roth S. Ischemic Optic Neuropathy in Cardiac Surgery Incidence and Risk Factors in the United States from the National Inpatient Sample 1998 to 2013. Anesthesiology. 2017;126:810–821. DOI: 10.1097/ALN.0000000000001533Baker M.L., Hand P.J., Wang J.J., Wong T.Y. Retinal signs and stroke — Revisiting the link between the eye and brain. Stroke. 2008;39:1371–1379. DOI: 10.1161/STROKEAHA.107.496091Baker M.L., Hand P.J., Wang J.J., Wong T.Y. Retinal signs and stroke — Revisiting the link between the eye and brain. Stroke. 2008;39:1371–1379. DOI: 10.1161/STROKEAHA.107.496091Bakalli A., Kocinaj D., Bakalli A., Krasniqi A. Relationship of hypertensive Retinopathy to Thoracic Aortic Atherosclerosis in Patients with Severe Arterial Hypertension. Clinical and Experimental Hypertension. 2011;33:89–94. DOI: 10.3109/10641963.2010.503307Bakalli A., Kocinaj D., Bakalli A., Krasniqi A. Relationship of hypertensive Retinopathy to Thoracic Aortic Atherosclerosis in Patients with Severe Arterial Hypertension. Clinical and Experimental Hypertension. 2011;33:89–94. DOI: 10.3109/10641963.2010.503307Kim Y., Cho J.S., Cho W.K., Yoon H.E., Hong Y.A., Chang Y.K., Yang C.W., Kim S.Y., Hwang H.S. Retinopathy and Left Ventricular Hypertrophy in Patients with Chronic Kidney Disease: Interrelationship and Impact on Clinical Outcomes. International Journal of Cardiology. 2017;249:372–376. DOI: 10,1016/j.ijcard.2017.06.123Kim Y., Cho J.S., Cho W.K., Yoon H.E., Hong Y.A., Chang Y.K., Yang C.W., Kim S.Y., Hwang H.S. Retinopathy and Left Ventricular Hypertrophy in Patients with Chronic Kidney Disease: Interrelationship and Impact on Clinical Outcomes. International Journal of Cardiology. 2017;249:372–376. DOI: 10,1016/j.ijcard.2017.06.123Bhatt D.L., Kandzari D.E., O’Neill W.W., D’Agostino R., Flack J.M., Katzan B.T., Leon M.B., Liu M., Mauri L., Negoita M., Cohen S.A., Oparil S., Rocha-Singh K., Townsend R.R., Bakris G.L. A Controlled Trial of Renal Denervation for Resistant Hypertension. The New England Journal of Medicine. 2014;370(15):1393–1401. DOI: 10.1056/NEJMoa1402670Bhatt D.L., Kandzari D.E., O’Neill W.W., D’Agostino R., Flack J.M., Katzan B.T., Leon M.B., Liu M., Mauri L., Negoita M., Cohen S.A., Oparil S., Rocha-Singh K., Townsend R.R., Bakris G.L. A Controlled Trial of Renal Denervation for Resistant Hypertension. The New England Journal of Medicine. 2014;370(15):1393–1401. DOI: 10.1056/NEJMoa1402670Tryfon R., Konstantinos A., Stelios B., Dimitrios B., Dimitrios S.L., Ioannis D.L. Multimodal Imaging of Hypertensive Chorioretinopathy by Swept-Source Optical Coherence Tomography and Optical Coherence Tomography Angiography. Medicine. 2017;96:39. DOI: 10.1097/MD.0000000000008110Tryfon R., Konstantinos A., Stelios B., Dimitrios B., Dimitrios S.L., Ioannis D.L. Multimodal Imaging of Hypertensive Chorioretinopathy by Swept-Source Optical Coherence Tomography and Optical Coherence Tomography Angiography. Medicine. 2017;96:39. DOI: 10.1097/MD.0000000000008110Song Y.S., Kinouchi R., Ishiko S., Fukui K., Yoshida A. Hypertensive Choroidopathy with Eclampsia Viewed on Spectral Domain Optical Coherence Tomography. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2013;251:2647–2650.Song Y.S., Kinouchi R., Ishiko S., Fukui K., Yoshida A. Hypertensive Choroidopathy with Eclampsia Viewed on Spectral Domain Optical Coherence Tomography. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2013;251:2647–2650.Stryjewski T.P., Papakostas T.D., Eliot D. Multimodial Imaging of Elschnig Spots: A Case of Simultaneous Hypertensive Retinaopathy, Choroidopathy, and Neuropathy. Seminars in Ophthalmology. 2016;15:1–3. DOI: 10.3109/08820538.2015.111509Stryjewski T.P., Papakostas T.D., Eliot D. Multimodial Imaging of Elschnig Spots: A Case of Simultaneous Hypertensive Retinaopathy, Choroidopathy, and Neuropathy. Seminars in Ophthalmology. 2016;15:1–3. DOI: 10.3109/08820538.2015.111509AlTalbishi A., Khateb S., Amer R. Elschnig’s Spots In The Acute And Remission Stages In Preeclampsia: Spectral-Domain Optical Coherence Tomographic Features. European Journal of Ophthalmology. 2015;25:e84–87. DOI: 10.5301/ejo.5000586AlTalbishi A., Khateb S., Amer R. Elschnig’s Spots In The Acute And Remission Stages In Preeclampsia: Spectral-Domain Optical Coherence Tomographic Features. European Journal of Ophthalmology. 2015;25:e84–87. DOI: 10.5301/ejo.5000586Steinegger K., Bergin C., Guex-Crosier Y. Malignant hypertension: clinical manifestations of 7 cases. Klinische Monatsblatter Fur Augenheilkunde. 2015;232:590–592.Steinegger K., Bergin C., Guex-Crosier Y. Malignant hypertension: clinical manifestations of 7 cases. Klinische Monatsblatter Fur Augenheilkunde. 2015;232:590–592.Estrada R., Allingham M.J., Mettu P.S., Cousins S.W., Tomasi C., Farsiu S. Retinal artery-vein classification via topology estimation. IEEE Transactions on Medical Imaging. 2015;34(12):2518–2534. DOI: 10.1109/TMI.2015.2443117Estrada R., Allingham M.J., Mettu P.S., Cousins S.W., Tomasi C., Farsiu S. Retinal artery-vein classification via topology estimation. IEEE Transactions on Medical Imaging. 2015;34(12):2518–2534. DOI: 10.1109/TMI.2015.2443117Saez M., González-Vázquez S., González-Penedo M., Barceló M.A., Pena-Seijo M., de Tuero G.C., Pose-Reino A. Development of an automated system to classify retinal vessels into arteries and veins. Computer Methods and Programs in Biomedicine. 2012;108(1):367–376. DOI: 10.1016/j.cmpb.2012.02.008Saez M., González-Vázquez S., González-Penedo M., Barceló M.A., Pena-Seijo M., de Tuero G.C., Pose-Reino A. Development of an automated system to classify retinal vessels into arteries and veins. Computer Methods and Programs in Biomedicine. 2012;108(1):367–376. DOI: 10.1016/j.cmpb.2012.02.008Mirsharif Q., Tajeripour F., Pourreza H. Automated characterization of blood vessels as arteries and veins in retinal images. Computerized Medical Imaging and Graphics. 2013;37(7–8):607–617. DOI: 10.1016/j.compmedimagMirsharif Q., Tajeripour F., Pourreza H. Automated characterization of blood vessels as arteries and veins in retinal images. Computerized Medical Imaging and Graphics. 2013;37(7–8):607–617. DOI: 10.1016/j.compmedimag

The authors declare that there are no conflicts of interest present.