WordNet

having abnormally high blood pressure
a person who has abnormally high blood pressure
a disease of the retina that can result in loss of vision

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高血圧の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/16 11:25:49」(JST)

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Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure (i.e. hypertension).

Pathophysiology

The changes in hypertensive retinopathy result from damage and adaptive changes in the arterial and arteriolar circulation in response to the high blood pressure.^{[citation needed]}

Symptoms

Most patients with hypertensive retinopathy present no visual symptoms. However, some may report decreased vision or headaches.^{[citation needed]}

Signs

Signs of damage to the retina caused by hypertension include:

Arteriolar changes, such as generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, changes in the arteriolar wall (arteriosclerosis) and abnormalities at points where arterioles and venules cross. Manifestations of these changes include Copper wire arterioles where the central light reflex occupies most of the width of the arteriole and Silver wire arterioles where the central light reflex occupies all of the width of the arteriole, and "arterio-venular (AV) nicking" or "AV nipping", due to venous constriction and banking.

advanced retinopathy lesions, such as microaneurysms, blot hemorrhages and/or flame hemorrhages, ischemic changes (e.g. "cotton wool spots"), hard exudates and in severe cases swelling of the optic disk (papilledema, or optic disc edema), a ring of exudates around the retina called a "macular star" and visual acuity loss, typically due to macular involvement.

Mild signs of hypertensive retinopathy can be seen quite frequently in normal people (3–14% of adult individuals aged ≥40 years), even without hypertension.^[1]

Keith Wagener Barker (KWB) Grades

Grade 1: Generalised arteriolar constriction - seen as `silver wiring` and vascular tortuosities
Grade 2: As grade 1 + irregularly located, tight constrictions - Known as `(AV) nicking` or `AV nipping`
Grade 3: As grade 2 + with cotton wool spots and flame-hemorrhages
Grade 4: As above but with swelling of the optic disk (papilledema)

There is an association between the grade of retinopathy and mortality. In a classic study in 1939 Keith and colleagues^[2] described the prognosis of people with differing severity of retinopathy. They showed 70% of those with grade 1 retinopathy were alive after 3 years whereas only 6% of those with grade 4 survived.The most widely used modern classification system bears their name.^[1] The role of retinopathy grading in risk stratification is debated, but it has been proposed that individuals with signs of hypertensive retinopathy signs, especially retinal hemorrhages, microaneurysms and cotton-wool spots, should be assessed carefully.^[1]

Differential Diagnoses

Several other diseases can result in retinopathy that can be confused with hypertensive retinopathy. These include diabetic retinopathy, retinopathy due to autoimmune disease, anemia, radiation retinopathy, central retinal vein occlusion.^{[citation needed]}

Treatment and management

A major aim of treatment is to prevent, limit, or reverse target organ damage by lowering the patient's high blood pressure and reduce the risk of cardiovascular disease and death. Anti-hypertensive drug treatment may be required to control the high blood pressure.

References

^ ^a ^b ^c Wong TY, Mcintosh R (2005). "Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality". British Medical Bulletin. 73-74: 57–70. doi:10.1093/bmb/ldh050. PMID 16148191.
^ Keith NM, Wagener HP, Barker NW (1939) Some different typs of essential hypertension: their course and prognosis. Am J Med Sci, 197, 332–43.

UpToDate Contents

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1. 高血圧の眼への影響 ocular effects of hypertension
2. 成人における中等度～重症の高血圧性網膜症および高血圧性脳症 moderate to severe hypertensive retinopathy and hypertensive encephalopathy in adults
3. 成人における高血圧の概要 overview of hypertension in adults
4. 成人における高血圧緊急症の評価および治療 evaluation and treatment of hypertensive emergencies in adults
5. 小児における高血圧緊急症および高血圧性急迫症に対するアプローチ approach to hypertensive emergencies and urgencies in children

English Journal

MicroRNAs: potential mediators and biomarkers of diabetic complications.

Kato M, Castro NE, Natarajan R.SourceDepartment of Diabetes, Beckman Research Institute, City of Hope, Duarte, CA 91010, USA.
Free radical biology & medicine.Free Radic Biol Med.2013 Sep;64:85-94. doi: 10.1016/j.freeradbiomed.2013.06.009. Epub 2013 Jun 12.
The incidence of diabetes is escalating worldwide and, consequently, this has become a major health care problem. Moreover, both type 1 and type 2 diabetes are associated with significantly accelerated rates of microvascular complications, including retinopathy, nephropathy, and neuropathy, as well
PMID 23770198

Interferon-associated retinopathy during the treatment of chronic hepatitis C: a systematic review.

Raza A, Mittal S, Sood GK.SourceDepartment of Surgery, Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.
Journal of viral hepatitis.J Viral Hepat.2013 Sep;20(9):593-9. doi: 10.1111/jvh.12135.
The incidence of retinopathy in patients with chronic hepatitis C treated with interferon-based regimens has been variably reported in the literature. There is no consensus regarding ophthalmologic screening before and during treatment with interferon-based therapy. To assess the incidence of retino
PMID 23910642

Hypertensive Retinopathy and Risk of Stroke.

Ong YT, Wong TY, Klein R, Klein BE, Mitchell P, Sharrett AR, Couper DJ, Ikram MK.SourceNUS Graduate School for Integrative Sciences and Engineering.
Hypertension.Hypertension.2013 Aug 12. [Epub ahead of print]
Although assessment of hypertensive retinopathy signs has been recommended for determining end-organ damage and stratifying vascular risk in persons with hypertension, its value remains unclear. In this study, we examine whether hypertensive retinopathy predicts the long-term risk of stroke in those
PMID 23940194

Japanese Journal

眼底画像における主幹動静脈の独立抽出法

医用画像情報学会雑誌 34(3), 136-140, 2017
NAID 130006146260

腎生検後に遅延性出血を来した悪性高血圧症関連血栓性微小血管症

臨床血液 58(6), 637-642, 2017
NAID 130005709595

強皮症腎クリーゼを呈し維持血液透析導入となった皮膚硬化を欠く限局型強皮症 (sine scleroderma) の1例

日本透析医学会雑誌 50(3), 207-212, 2017
NAID 130005494040

Related Pictures

★リンクテーブル★

リンク元	「高血圧性網膜症」「ロス斑」
関連記事	「hypertensive」

「高血圧性網膜症」

Hypertensive retinopathy
	Classification and external resources
	Hypertensive retinopathy with AV nicking and mild vascular tortuosity
ICD-10	H35.0
ICD-9	362.11
MedlinePlus	000999
MeSH	D058437

　　[★]

英: hypertensive retinopathy
ラ: retinopathia hypertonica
同: 高血圧網膜症。
関: シャイエ分類。(高血圧性眼底、高血圧眼底。高血圧性網膜症の概念の中だが、より軽度なもの？)

[show details]

高血圧性網膜症 : 約 45,800 件
高血圧網膜症 : 約 38,500 件

概念

高血圧により網膜細動脈にもたらされた変化により生じる網膜の病的変化

網膜細動脈は狭細化と口径不同となり、網膜の循環障害により、出血、網膜浮腫、綿花状白斑、硬性白斑がもたらされる。

分類 (SOP.131)

高血圧による眼底変化は二軸に分類される。

1. 動脈硬化性変化：∝高血圧の期間
2. 高血圧性変化　：∝高血圧の重症度

1. 動脈硬化性変化(SOP.132)

網膜における細動脈の硬化性変化のことである。
高血圧により血管壁が肥厚して透明性を失う結果、血管壁の反射が変化する
肉眼所見における変化

(血管壁反射の亢進)　→　銅線化(銅線動脈)　→　銀線化(銀線動脈)
細動脈硬化により硬化した動脈周囲の不透明化、静脈の圧排、軸方向の伸張

組織学的変化：内皮・弾力線維・結合織の増殖、内膜の硝子様変性

2. 高血圧性変化(SOP.132)

血圧上昇が緩徐：細動脈の狭小化　∝　血圧。走行は直線的。
血圧上昇が急激：血管の拡張。走行は蛇行屈曲　→　細動脈の太さが不均一　→　毛細血管前動脈の閉塞による綿花様白斑、透過性亢進による出血・浮腫・硬性白斑　→　乳頭浮腫
血圧上昇が高度で急激(急性腎炎、妊娠高血圧)：(網膜)細動脈の線維素性壊死を生じ、細動脈の口径不同・網膜浮腫・綿花様白斑、出血、乳頭浮腫、星状白斑。(脈絡膜)血管攣縮　→　毛細血管前菜動脈の閉塞　→　網膜色素上皮の壊死

高血圧眼底と細動脈硬化の程度分類(SOP.132)

キース-ワゲナー分類：網膜血管病変を一系列として段階分類
シャイエ分類：高血圧性変化と硬化性変化を別々に分類し評価

キース・ワグナー分類 Keith-Wagener分類

0群：正常
I群：わずかな血管腔狭小化・動脈硬化
II群：銅線動脈・交叉現象
III群：口径不動・軟性白斑・星状斑、そのほか滲出物・網膜浮腫・様々の形の出血。
IV群：乳頭浮腫

I群・II群：慢性高血圧 or 本態性高血圧

III群・IV群：急性に著しく血圧上昇が起こったときなどに

シャイエ分類 Scheie分類

細動脈硬化(S)

I度：動脈壁反射亢進、交叉現象軽度
II度：反射亢進がより著明、交叉現象中等度
III度：銅線動脈、交叉現象著明
IV度：銀線動脈

高血圧性変化(H)

I度：わずかの細動脈細小を認めるもの
II度：細動脈に口径動脈が加わる
III度：出血・白斑が加わる
IV度：乳頭浮腫

「ロス斑」

　　[★]

英: Roth spot, Roth spots, Roth's spots
同: Roth斑

概念

ロス斑は白斑を中心と中心とする出血像を示す。ロス斑は綿花状白斑の周りを出血が取り囲んでいる。綿花用白斑は虚血に陥った軸索の膨化(破裂?, bursting)により生じている。毛細血管に入る前の細動脈が虚血により破裂することにより生じている。多くの病態でロス斑が起こるのであって、細菌性心内膜炎に特異的なわけではない。(参考(1))

原因

参考3

亜急性細菌性心内膜炎 subacute bacterial endocarditis
白血病 leukaemias
貧血 anaemia
無酸素症 anoxia
一酸化炭素中毒 carbon monoxide poisoning
prolonged intubation during anaesthesia
高血圧網膜症 hypertensive retinopathy
妊娠高血圧腎症 pre-eclampsia
糖尿病性網膜症 diabetic retinopathy
新生児分娩時損傷 neonatal birth trauma
外傷伴う出産 mothers who have undergone traumatic deliveries
被虐待児症候群/揺さぶられっ子症候群 battered children / shaken baby syndrome
動静脈奇形に起因する頭蓋内出血 intracranial hemorrhage from arteriovenous malformation
線維柱帯切除術後の眼球内圧の減圧 ocular decompression following trabeculectomy

参考

1.

http://www.kellogg.umich.edu/theeyeshaveit/optic-fundus/roth-spot.html

2.

http://www.nejm.org/doi/full/10.1056/NEJMicm040783

3. Roland Ling, Bruce James White-centred retinal haemorrhages(Roth spots). Postgrad Med Ja 1998;74:581-582

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361020/pdf/postmedj00094-0007.pdf

4

http://www.uveitis.org/medical/articles/case/Uveitis-%20Roth%20Spots.pdf

5.写真

http://www.kellogg.umich.edu/theeyeshaveit/optic-fundus/images/roth-spot.jpg

「hypertensive」

　　[★]

adj.

高血圧性の、高血圧の

関: HBP、high blood pressure、HT、hypertension

[Wong_2005-1] Wong TY, Mcintosh R (2005). "Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality". British Medical Bulletin. 73-74: 57–70. doi:10.1093/bmb/ldh050. PMID 16148191.

[2] Keith NM, Wagener HP, Barker NW (1939) Some different typs of essential hypertension: their course and prognosis. Am J Med Sci, 197, 332–43.

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案内

案内

hypertensive retinopathy