Association of serum ferritin levels with severity of hypertensive retinopathy

Abstract

Introduction: Hypertensionis the most important public health problem in developing and developed nations. High blood pressure is defined as BP greater than or equal to 140/90 mm Hg following repeated examination and it applies to all adults (more than 18 years old). Hypertensive retinopathy is one of the micro vascular complications of hypertension, which if left untreated, can lead to retinal vascular occlusion, ischemic optic neuropathy and vitreous haemorrhage. The present study assesses the association of serum ferritin levels with severity of hypertensive retinopathy. Objective: To study the correlation between serum ferritin levels and hypertensive retinopathy. Material and methods: The present study was conducted prospectively in the Upgraded Department of Ophthalmology, Government Medical College, Jammu for a period of 1 year w.e.f 1^stNovember 2021 to 31^stOctober 2022.All patients, aged above 18 years diagnosed with hypertension (JNC 8 Criterion) attending the OPD of upgraded Department of Ophthalmology, Government Medical College, Jammu for fundoscopic examination with complaints of diminution of vision were included in the study. The cases were non selective with regards to sex, ethnic origin, and occupation and controls included normotensives above 18 years age without any other systemic illness. Exclusion criteria: The study excluded patients with age< 18 years, those in whom dilatation of pupil is contraindicated, Primary open angle glaucoma and angle closure glaucoma, patients with hazy media with impaired visualization of fundus, patients havingdiabetes mellitus, liver or kidney disease, dyslipidaemia, recent surgery, cerebral disease, anaemia, stroke, pregnant and lactating females and patients taking iron in oral or i/v formulation. Results: The present study was conducted in 50 patients with hypertensive retinopathy and 50 controls without HR.The mean age of the patients with HRwas 56.42±10.90 years and we observed a male predominance. No significant difference was seen among both the groups with respect to age(p=0.93) and gender(p=0.216). The BMI in cases was 28.02±2.91while in control it was 26.58±2.06. The BMI index was significantly more in cases than control. The SBP in cases was 157.96± 11.13 while in controls, it was 117.36±7.34. When the SBP was compared between the grade 1 hypertensive retinopathy (157.36±10.35) and grade 2 HR (158.56±12.03), no significant difference was observed.   Similar trends were observed with DBP. The mean DBP of control was 112.20±8.16 (grade 1 HR : 112±9.01 vs   grade 2 HR: 112.40±7.39 ) while in controls, the mean DBP was 79.86±4.00. the difference of SBP and DBP was highly significant(p<0.001). In present study we observed that FBS, Total cholesterol, HDL, triglyceride, CRP doesn’t show any significant difference among cases and control. Whereas creatinine and LDL were significantly more in cases (although in normal range in both the groups). Serum ferritin was significantly more in cases (87.68±51.64 ng/dl) than in controls (63.98±20.92ng/dl).However, it was observed that when grade 1(80.20±36.45) and grade 2 HR(95.16±63.24)  were compared, subjects with grade 2  hypertensives showed more serum ferritin levels than grade 1 ,although the comparison was not statistically significant. Conclusion: Our study suggests that there is a relationship between HR and ferritin level, which may be associated with an increased level of oxidative stress. Hence the estimation of the serum ferritin levels can help the medical professionals to predict early development of hypertension as well as hypertensive retinopathy.