Little Old Ladies’ Eye
We recently encountered an older patient with severe hypertensive retinopathy on her right eye who had been normotensive all her life as documented not only by serial office blood pressure measurements but also with ambulatory blood pressure monitoring. Unappreciated hypertension, is said to be masked from view and therefore, unappreciated and untreated. Masked hypertension is currently defined as existent hypertension even though office indirect brachial artery measurements with syphygmomanometry are normal. The condition can be detected by 24-h Ambulatory Blood Pressure Monitoring (ABPM) or with home blood pressure measurements. However, our concern here is not the blood pressure at the brachial artery. The hand is seldom the site of target-organ damage. Our issue is what happens centrally. Can the central aortic hypertension be masked when only brachial artery measurements are considered? This is obviously the case with our patient.
Augmentation designates the added systolic pressure contributed by the reflected pulse wave in stiff arteries with increasing age. As a result, the central aortic pressure progressively increases and is subsequently higher than the peripheral pressure at the brachial artery. The stiffer the vessels and the shorter the aorta as in short patients, the faster the pulse-wave velocity and the reflected pulse-wave, and the greater is the augmentation effect on systolic central aortic blood pressure.
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