Epidemiological Investigation Of Hypertensive Retinopathy In Part Residents Of Shandong Province

Hypertension is the most common systemic disease. Current epidemiological data show that the prevalence rate of hypertension in China is high, but the awareness rate, treatment rate and control rate of hypertension are relatively low. So in some patients, it can cause serious complications, such as cardiovascular and cerebrovascular diseases. Hypertention is one of the most serious diseases endangering the people’s health. The pathological changes of the retinal vessels caused by hypertension are one part of the systemic vascular changes, so it can reflect the situation of arteries in vivo to a certain degree. The retinal vascular is normal in the early stage of hypertension usually, but with the increasing of blood pressure and the course of hypertension,90%of the retinal vascular has a series change of diameter and wall gradually which is called the characteristic retinopathy. Retinal blood vessels are the only vessels which can be directly observed by ophthalmoscope. By observing the characteristic changes in retinal blood vessels of hypertension patients, we can learn about the severity of other organs’ damage caused by hypertension. So it has a certain value for us to know the severity and prognosis of hypertension. Therefore, epidemiological investigation of hypertensive retinopathy will be contributing for prevention and control of both hypertensive retinopathy and hypertension.The objects in epidemiological investigation of diseases mainly have two sources:one is the clients in hospitals, another is the natural population. The first one is easy to organize, and we can obtain much information with less time and cost, but the prevalence rate we got may be higher. The second one is difficult to organize, and it may consume a great deal of manpower and financial resources, but it can reflect the true prevalence of the residents. In this research, with the close cooperation of Shandong Province Center for Disease Control and Prevention, we conducted an epidemiology study on prevalence and related risk factors of hypertensive retinopathy in Ningyang County, Shandong Province, so as to provide a basis for enacting related policy on blinding prevention and control. At the same time, we contacted several hospitals in Ji’nan city and studied clinical epidemlology of hypertensive retinopathy in-patients with hypertension in Jinan city and analyze its related factors. Part Ⅰ:Epidemiological investigation of hypertensive retinopathy in the residents of Ningyang county in Shandong province.Objective:To study the prevalence of hypertensive retinopathy in the residents of the Ningyang county in Shandong province and analyze its related risk factors. To explore the economic and effective prevention and control mode of hypertensive retinopathy. To reduce the rate of blindness caused by hypertensive retinopathy through the corresponding health education and early diagnosis and treatment.Methods:Bying random cluster sampling (qualified residents cluster sampling), two Ningyang county urban communities and eight villages were chosed. Some people above35years old in the areas were investigated with questionnaire survey, physical and eye examinations. The contents of the questionnaire included general condition (name, gender, age, living habits, etc), the history of hypertension, family disease history, treatment and control of blood pressure, eye disease history, diabetes and hyperlipemia disease history. Eye examinations included bare eye visual acuity, slit lamp examination of corneal, iris, lens, anterior chamber and anterior vitreous, intraocular pressure measurement by non-contact tonometer and examination of fundus after mydriasis by compound tropicamide eye drops with VOLK90D lens. If the subjects had shallow anterior chamber then did direct ophthalmofundoscope through small pupil. Both two eyes were examined if binocular refractive interstitial was clear in an individual. If the retinopathy was different in right eye and left eye, we recorded the severe one. If one eye had serious cataract or vitreous opacity, we recorded another eye. If the classification was difficult in some eyes, all the ophthalmologists should be given a common diagnosis.SPSS13.0was used in statistical treatment. The four table chi-square tests were used in comparison of prevalence in two samples. Trend chi-square tests were used in comparison of prevalence in more than two groups.We took a=0.05, P<0.05as a significant test. HR was taken as the dependent variable, assigned0as normal,1as HR grade1,2as HR grade2,3as HR grade3. City/rural, sex, age, course of disease, systolic hypertension, systolic hypertension, mixed type hypertension were taken as independent variables. Multiple regression analysis was carried out. All of the data were collected by two people repeatedly in order to ensure the accuracy.Results:1328cases (566males and772females) were diagnosed as hypertension in all the subjects. Including the newly diagnosed patients and the patients already diagnosed with hypertention (they might have normal blood pressure since using antihypertensive drugs). The prevalence rate of hypertension was41.20%. Due to the incomplete information,242cases were not included in the statistical results. The other1086subjects completed questionnaires and eye examinations, including446males and640females, aged from35to89years old. The ratio of male to female was1:1.43and the average age was57.85years old.859cases (79.1%) knew that they had hypertension, and342cases(31.49%) had taken drug treatment. Only79cases(7.27%) knew that they had hypertensive retinopathy. In all the1086hypertension patients, there were303cases with normal fundus,783cases with hypertensive retinopathy of different degree.53cases (6.77%) had ocular complications, including retinal arterial obstruction(2cases), retinal vein obstruction(5cases), preretinal membrane (9cases), macular degeneration(34cases), retinal vein thrombosis complicated with neovascular glaucoma(1case), and vitreous hemorrhage(2cases).1. The prevalence of hypertensive retinopathy in county and rural population of Ningyang. The prevalence of hypertensive retinopathy in the rural residents was73.68%, which was clearly higher than that in county residents (64.82%). There was statistically significant (P<0.05).2. The prevalence of hypertensive retinopathy (HR) in residents of different sex in Ningyang. Male and female HR prevalence showed no statistically significant difference (P>0.05).3. The prevalence of hypertensive retinopathy of different age groups in Ningyang. With the increase of age, the prevalence rate of HR increased (P<0.05).4. The prevalence of hypertensive retinopathy in residents of different systolic blood pressure (SBP) and diastolic blood pressure (DBP) groups in Ningyang. With the increase of systolic blood pressure and diastolic blood pressure, the prevalence rate of HR increased (P<0.05).5. The prevalence of hypertensive retinopathy in residents of different course of hypertension in Ningyang. There was a certain correlation between the course of hypertension and the prevalence rate of HR. With the increase of hypertension course, the prevalence rate of HR increased (P<0.05).6. The results of Multiple factors analysis. In the same age group, if the duration of hypertension was longer, the prevalence rate of HR was higher. In the same course of hypertension group, the prevalence rate of HR was higher in high age group than that of in low age group. By ordinal logistic regression analysis, age, county/rural, course of hypertension were risk factors of HR. The prevalence rate of HR in mixed type hypertension group was2.44times than that of in normal blood pressure group. If the duration of hypertension was more than5years, the risk of HR would be2.67times than that of less than1year. If the duration of hypertension was more than10years, the risk of HR would be4.15times than that of less than1year.Conclusions:The prevalence of hypertensive retinopathy in Ningyang was relatively high. And it was characterized with low awareness rate, low treatment rate and low control rate. The risk factors included blood pressure, age, residential area, the course of hypertension. Ophthalmologists need to cooperate closely with the medical institutions at all levels to establish the prevention and control system of hypertensive retinopathy. PART II:Epidemiological investigation of hypertensive retinopathy in in-patients with Hypertension in Jinan city.Objective:To study the prevalence of hypertensive retinopathy in in-patients with primary hypertension in Jinan city and analyze its related factors.Methods:300inpatients with primary hypertension in several hospitals of Jinan city were investigated in detail by questionnaire investigation, laboratory and physical examinations, and ocular examinations. Questionnaire investigation and ocular examinations were similar with part Ⅰ. Besides, some inpatients had eye-ground photography and FFA. Laboratory tests were including fasting blood glucose (FBG), total cholesterol(TC), triglyceride(TG), high density lipoprotein(HDL), low density lipoprotein(LDL), urine albumin(mAlb) and ultrasound heartbeat graph examination. Physical examination including blood pressure (BP), height, weight and waist circumference were also carried out.SPSS13.0was used in statistical treatment. The four table chi-square tests were used in comparison of prevalence in two samples. HR was taken as the dependent variable age, course of hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), TC, TG, HDL, LDL, FBG and UA were taken as independent variables. Multiple regression analysis was carried out. The ratio of retinal arteriolar-to-venular diameter (AVR) was measured on computers with the Image J. All of the data collected were inputed by two people repeatedly in order to ensure the accuracy.Results:There were108males and192females in all the300hypertension inpatients. There were236cases of hypertensive retinopathy in all the300hypertension inpatients(84males and152females)(78.7%). And the prevalence of hypertensive retinopathy in stage Ⅰ,Ⅱ,Ⅲ, Ⅳ was26.0%,33.3%,17.3%and2%respectively.24cases(10.17%) knew that they had hypertensive retinopathy,20cases(8.47%) had ocular complications, including anterior ischemic optic neuropathy(9cases and12eyes), central retinal vein occlusion (2cases), branch retinal vein occlusion(2case), central retinal artery occlusion (1 cases), macular degeneration(5case) and vitreous hemorrhage(1case).1. The prevalence of hypertensive retinopathy (HR) in different sex of the hypertension inpatients in Jinan city. The prevalence of different sex showed no statistically significant difference (P>0.05).2. The prevalence of HR in deferent age groups of hypertension inpatients in Jinan city. The age of the subjects in this survey was from47to86years old. The average age was65.96. With the increase of age, the prevalence rate of HR increased, but there was not statistical significance (P>0.05).3. The prevalence of HR in hypertension inpatients of different systolic blood pressure (sbp) and diastolic blood pressure (dbp) groups in Jinan. With the increase of systolic blood pressure and diastolic blood pressure, the prevalence rate of HR increased (P<0.05).4. The prevalence of HR in hypertension inpatients of different course of hypertension. The course of hypertension in hypertension inpatients was from6to27years. With the increase of hypertension course, the prevalence rate of HR increased (P<0.05).5. Single factor analysis of clinical index between case and control groups. We took the hypertension inpatients with hypertensive retinopathy as case group, the hypertension inpatients without hypertensive retinopathy as control group. By single factor analysis, course of hypertension, triglyceride(TG), diastolic blood pressure(DBP), systolic blood pressure(SBP), and Urinary albumin(UA) had significantly difference between two group(P<0.05). The other clinical index had no significantly difference between two group (P>0.05)6. Multiple regression analysis.By multiple regression analysis, course of hypertension, triglyceride (TG), diastolic blood pressure(DBP), systolic blood pressure(SBP), and Urinary albumin(UA) were risk factors of HR.7. The relationship between hypertensive retinopathy and left ventricular hypertrophy. We took the hypertension inpatients without hypertensive retinopathy as control group, the hypertension inpatients with hypertensive retinopathy grade Ⅰ and grade Ⅱ as case1group, gradeⅢ and grade Ⅳ as case2group.The left ventricular weight in the three groups were significantly different (P<0.05).8. The analysis of the ratio of retinal arteriolar-to-venular diameter (AVR).The value of the AVR in4major blood vessels, the superior temporal artery and vein, the inferior temporal artery and vein, the superior nasal artery and vein,and the inferior nasal artery and vein, was no significant difference. The AVR of hypertension group was significantly lower than that of the normal group.Conclusions:The prevalence of hypertensive retinopathy was high in hypertension inpatients of Jinan city. And it was more severe than in the population sampling survey. Course of hypertension, TG, DBP, SBP, and mAlb were risk factors of HR. AVR in group with hypertension was significantly less than the normal group. Image J software had certain advantages in the quantitative analysis of retinal vessel diameters.The fundus examination should be strengthened, especially in the hypertension patients with long course and combined with hyperlipemia or renal function abnormal.To prevent or reduce the occurrence of hypertensive retinopathy, blood pressur should be under good control.