258 

Journal of Andalas. Health Journal of Andalas. 2018; 7 (2) 

Research Article 
Description of Characteristics of Patients with Hypertensive 
Retinopathy 
Coming to the Polyclinic of RSUP DR. M. Djamil 
Padang. 
Adila Hanna 
1 
, Hendriati 
2 
, Kemala Sayuti 
3 
Abstract 
Hypertensive retinopathy is one of the target organ damage due to high blood pressure, which can 
cause retinal and blood vessel abnormalities in the retina. The purpose of this study was to identify 
characteristics of hypertensive retinopathy patients in RSUP DR. M. Djamil Padang from 2015 to 2016. This 
type of research is descriptive with cross sectional design. This research was conducted from November to 
February 2018 in the medical record center of RSUP DR. M. Djamil Padang. The sample consisted of 80 medical 
records of patients 
diagnosed with hypertensive retinopathy recorded in medical records. From 80 medical records, 74 medical records 
of 
patients fulfilled the sample criteria. From 74 patients, the majority of patients were> 60 years old (with an average 
age of 57.6 years), female sex dominated (51.4%), the majority of sufferers were working taking care of 
the household (31.1%), suffering from stage 1 hypertension and having suffered hypertension for 1-5 years (63.5%, 
with an average of 5.5 years). The majority of sufferers do not have damage to other target organs. The conclusion of 
this study is the 
majority of patients with hypertensive retinopathy in RSUP DR. M. Djamil Padang from 2015 to 2016 is a 
woman and is over 60 years old. The majority of patients are housewives, have suffered fromhypertension 
stage 1for 1-5 years and do not have damage to other target organs. 
Keywords: hypertensive retinopathy, hypertension, damage to target organs 
Abstract 
Hypertensive retinopathy is one of the target organs for high blood pressure which causes the 
defects of retina and retinal vascularization. The objective of this study was to identify the characteristic of 
hypertensive 
retinopathy Patients at DR. M. Djamil Padang from 2015 until 2016. This was a descriptive cross 
sectional design study. This study was held from November until February 2018 in the medical record center of 
RSUP 
DR. M. Djamil Padang. Samples of the 80 of medical records of patients who were diagnosed with hypetensivewho 
were 
retinopathystated in the medical record. From those 80 medical records, there were 74 medical records that 
qualified the sample criterias. Out of 74 patients, 60 years (with 57.6 mean mean), 
female were found preponderance (51.4%), majority of patients were housewives (31.1%), had stage 1 in 
hypertension 
(45.9%) and have been suffering from hypertension for 1-5 years (63.5%, with 5.5 as mean years). Majority 
ofReviews These 
Patientscompanies did not have a target organ damage.In conclusion, most of hypetensive retinopathy Patients at 
Hospital Dr. M. 
Djamil Padang from 2015 until 2016 were females and above 60 years old. Most of the Patients had occupation as 
housewives, had been having stage 1 hypertension for 1-5 years and did not suffer from other target-organ damage. 
Keywords: hypertensive retinopathy, hypertension, target organ damage 
Affiliation: 1. Medical Study Program, Faculty of Medicine 
, Padang Andalas University (Unand FK), 2. Eye Health Sciences FK 
Unand, 3. Eye Health Sciences FK Unand 
Correspondence: Adila Hanna, Email: 
adilahanna .apple @ gmail.com, Tel: 081266503766 
 
INTRODUCTION 
Hypertension is persistent blood pressure 
above or equal to 140/90 mmHg.persistence 
Increasedmeans that the increase in blood pressure is not 
transient or is only aincrease 
diurnalin normal blood pressure according to thecycle 
cyclic. Many consensus and guidelines for 
hypertension grading, one of which is JNC VII which 
classifies pre-hypertension with systolic / 
diastolic 120-139 / 80-89, stage 1 with 
systolic / diastolic 140-159 / 90-99 and stage 2 with 
systolic / diastolic> 160/100 mmHg. Hypertension is divided 
into primary hypertension and secondary hypertension which isto 
knownbe the etiology. Primary hypertension is caused 
by an unknown etiology, but therefactors 
are influencingsuch as obesity,resistance 
insulin, high salt intake,alcohol 
excessiveconsumption, aging, sedentary lifestyle, stress, 
low calcium and potassium intake. 
1 
hypertension 
Secondaryis known as its etiology, such as disease ( 
chronic renal failure) and drugs (prednisone). 
2 The 
World Health Organization (WHO) reports that 
hypertension is ahealth problem 
global, especially in countries with 
low to middle income. The prevalence of hypertension in 
countries with low to medium income 
is higher than countries withincome 
high. 
3 
Hypertension is still a big challenge in 
Indonesia, which is a country with 
low to middle income. This is evidenced by 
hypertension, which is one of the mostdiseases 
commonfound in primary health care. 
Although effective hypertensive drugs are widely 
available and easily accessible, controlling 
hypertension is still inadequate. 
4 
The prevalence of hypertension 
in Indonesia is 26.5%. The provinces with the 
highest prevalence were Bangka Belitung 
(30.9%), followed by South Kalimantan (30.8%), 
East Kalimantan (29.6%) and West Java (29.4%). 
5 
In addition, West Sumatra has a prevalence of 
hypertension in the population over the age of 18 
by 7.8% based on diagnosis byworkers 
health, 7.9% based on diagnosis byworkers 
healthor taking hypertension drugs and 22.6% 
based on measurement results. 
6 
259 http://jurnal.fk.unand.ac.id 
The bad consequences of hypertension are also 
exacerbated because many people affected by 
hypertension also have other risk factors that are not 
directly related to hypertension, 
increasing the likelihood of heart attack, 
stroke and kidney failure. Other risk factors 
include smoking, obesity, high cholesterol and 
diabetes mellitus. In 2008, the world prevalence of 
obesity and smokers (to one billion 
people) has doubled since 
1980. The prevalence of the world in people who 
suffer from high cholesterol is 39% and 
those who have diabetes are 10% in the past 
25 years. 
3 
Uncontrolled hypertension will 
cause damage to the retinal microcirculation 
which will lead to hypertensive retinopathy. 
Hypertensive retinopathy shows ophthalmic findings 
on end-organ secondary damage due to 
hypertension. The ophthalmic findings are in the form ofabnormalities 
vascular(general or local narrowing), 
sharp branches of blood vessels, the phenomenon of 
crossing or vascular sclerosis. 
7 
studies 
population-based epidemiologicalonretinopathy 
hypertensivephotography is done with the 
retinalexamination.This study is a combination of studies 
conducted in the United States, Australia, the Netherlands, 
Singapore, Japan and China. In the past decade 
, data from this study have shown that 
hypertensive retinopathy occurs in 3% to 14% 
of adults who do not have diabetes and are 
over 40 years old. 
8 
Hypertensive retinopathy has been a marker of 
other organ microvascular damage over the 
past decade. 
8 
Data from population-based studies 
show that hypertensive retinopathy is associated 
with an increased risk of cardiovascular disease, 
independent of other risk factors. 
The Other Sclerosis Risk in Communities (ARIC) 
reports individuals with microaneurysms, 
retinal bleeding and soft exudates may be 2-3 
times more likely to suffer a stroke than 
individuals without retinal lesions, free from diabetes, 
smoking, dyslipidemia and other risk factors.study 
Thisalso showed that hypertensive retinopathy of 
the Andalas Health Journal. 2018; 7 (2) 
 
is closely related to high blood pressure, 
but is not closely related to high 
cholesterol levels and other risk factors for atherosclerosis 
. The evaluation of the findings of hypertensive retinopathy 
related to the risk ofcardiovascular diseases is 
otheralso supported bymanagement institutions 
international hypertension, including the JNC (Joint National 
Committee) VII and the British Hypertension Society. Both 
institutions mentioned that hypertensive retinopathy 
can be evaluated as an indicator ofdamage 
end-organ, namely left ventricular hypertrophy andrenal failure 
chronic. 
9 
METHODS The 
type of research conducted was 
descriptive with a cross sectional study design. 
This research was conducted after obtaining 
ethical clearance from the Ethics Research Commission of the 
Faculty of Medicine of Andalas University with 
letter number 477 / KEP / FK / 2017. The population in 
this study were all medical records of patients with 
hypertensive retinopathy who came for treatment at thePolyclinic of 
EyeRSUP DR. M. Djamil Padang for the period of 2015 and 
2016. The inclusion criteria were all medical records of 
patients with hypertensive retinopathy who came for treatment at 
the Eye Polyclinic of RSUP DR. M. Djamil Padang in the period 
2015 and 2016 who have completerecord data 
medical. The exclusion criteria were medical records of patients with 
hypertensive retinopathy who were treated at the Eye Polyclinic of 
RSUP DR. M. Djamil Padang in the 2015 and 2016 periods 
who also had diabetic retinopathy, 
hyperviscosity syndrome, radiation retinopathy or 
ischemic ocular syndrome. The sampling technique 
uses total sampling, so that the 
total number of samples is 74 samples. 
The research was conducted from January 15, 2017 
to February 15, 2015 at RSUP DR. M. Djamil 
Padang. Data were collected and collected from all 
medical records of patients diagnosed withretinopathy 
hypertensive. Data were then recorded according to age, 
sex, occupation, hypertension stagestage 
, hypertensive retinopathy, duration of hypertension and 
other target organ damage. Data is then processed manually. 
260 http://journal.fk.unand.ac.id 
RESULTS 
Table 1. Frequency distribution ofretinopathy patients 
hypertensivebased on age 
Age f% 
<40 years 3 4.0% 
40-49 years 7 9.5% 
50-59 years 25 33.8% 
> 60 years 39 52.7% 
74 100% 
In the above table it was found that more than 
half (52.7%) of hypertensive retinopathy patients 
aged over 60 years and only a small percentage 
(4%) were less than 40 years old. 
Table 2. Frequency distribution ofretinopathy patients 
hypertensiveby sex 
Gender f% 
Male 36 48.6% 
Female 38 51.4% 
74 100% 
In Table 2 it was found that more than half 
(51.4%) of hypertensive retinopathy patients had the type 
female sex and almost half 
(48.6%) of hypertensive retinopathy sufferers have 
male sex. 
Table 3. Frequency distribution ofretinopathy patients 
hypertensivebased on occupation 
Job f% 
Managing 
Households 
23 31.1% 
Students / Students 1 1.3% 
Retired 12 16.2% 
Civil Servants 15 20.3% 
Transportation 2 2.7% 
Entrepreneurs 6 8.1% 
Others 15 20.3% 
74 100% 
In Table 3 it was found that almost half 
(31.1%) of hypertensive retinopathy patients had a 
job taking care of the household and 
a small proportion (1.3%) had employment as 
students / college student. 
Andalas Health Journal. 2018; 7 (2) 
 
Table 4. Frequency distribution ofretinopathy patients 
hypertensivebased on hypertension 
stage Hypertension Stadium f% 
Prehypertension 25 33.7% 
Stadium 1 34 45.9% 
Stage 2 15 20.3% 
74 100% 
In Table 4 it is obtained almost half 
( 45.9%) hypertensive retinopathy sufferers suffering from hypertension 
stage 1 and a small proportion (20.3%) 
suffering from stage 2 hypertension. 
Table 5. Frequency distribution ofretinopathy patients 
hypertensivebased on hypertensive retinopathy stage 
Retinopathy 
Hypertensive 
f% 
KW I 25 33.8% 
KW I-II 4 5.4% 
KW II 
KW II-III 
KW III 
KW IV 
38 
1 
3 
3 
51.3% 
1.3% 
4.1% 
4.1% 
74 100% 
In Table 5 obtained more than half 
( 51.3%) patients with hypertensive retinopathy suffered from 
stage II hypertensive retinopathy and a small proportion 
(1.3%) suffered from hypertensive retinopathy KW II-III. 
Table 6. Frequency distribution ofretinopathy patients 
hypertensivebased on the duration of suffering from hypertension 
Long Suffering 
Hypertension 
f% 
1-5 th 47 63.5% 
6-10 th 20 27% 
> 10 th 7 9.5% 
74 100% 
In Table 6 obtained more than half 
(63.5%) of hypertensive retinopathy sufferers suffer from 
hypertension for 1-5 years and only aproportion 
smallsuffer from hypertension for more than 10 years (9.5%). 
261 http://jurnal.fk.unand.ac.id 
Table 7. Frequency distribution ofretinopathy patients 
hypertensivebased on other target organ 
damage TargetDamage 
Other Organ 
f% 
CNS 5 6.7% 
Heart 22 29.7% 
Kidney 2 2.7 % 
None 48 64.9% 
74 
In Table 7, more than half of 
patients with hypertensive retinopathy did not suffer 
damage to other target organs (64.9%) and apercentage 
small(2%) suffered damage to target kidney organs. 
DISCUSSION The 
study by Leung et al in 2003 at Blue 
Mountain, Australia usingfunduscopy 
retinaland Retinal Analysis software in 3355 
men and women aged 49 years and over, 
showed every decade of age increase in 
men and women, on average CRAE (central 
retinal artery equivalent) in 
men and women decreased by 4.2 μm-5.7 μm and 
CRVE average in men and women (central retinal 
vein equivalent, mean width venules) decreased by 3.9 
μm. Average AVR (arteriol to venule ratio, obtained 
from CRAE divided by CRVE) also decreases with 
age, which is a decrease of 0.01 μm when it 
reaches the age of 80 years. 
10 
Therefore, it can be 
concluded that arterioles and venules are 
narrowing with age, so that 
hypertensive retinopathy will be more frequently found 
in older ages. This is also supported by the 
journey of atherosclerosis which will get worse 
as we age, so it will 
increase blood pressure vasospastic and 
worsen hypertension, then it will 
cause target organ damage due to 
hypertension. 
11 
Andalas Health Journal. 2018; 7 (2) 
 
NHANES II and NHANES III conclude that 
increased blood pressure in women that 
exceeds the increase in blood pressure in men 
occurs in the fifth and sixth decades of life.26 
Increased blood pressure in women is related 
to hormonal changes that occur when 
women enter menopause . 
Estrogen has a role in protecting women 
against hypertension. Estrogen stimulates the production of 
nitric oxide (NO) which has a role 
in vasodilation of blood vessels, which can 
reduce blood pressure. Estrogen is no longer 
produced when women have entered 
menopause, so there is no longer any protective effect of 
hypertension in women who have entered 
menopause. 
11 
Changes in androgen levels also 
play a role in high blood pressure in 
post-menopausal women, this is 
because androgens affect sodium reabsorption 
in renal nephrons and stimulate the 
renin-angiotensin system, thus influencing 
high blood pressure. 
12 
Many sufferers of 
hypertension are female, so 
women will also suffer moredamage 
organdue to hypertension, one of which isretinopathy 
hypertensive. 
The incidence of hypertension is related to 
physical activity carried out by someone. In 
the ACLS study, good cardiorespiratory fitness 
will reduce the incidence of hypertension. The study 
divided the sample categories, people 
with good cardiorespiratory fitness and 
people with bad cardiorespiratory fitness 
. People with good respiratory fitness are 
reported to have a 26-28% lower incidence of 
hypertension than people 
with bad cardiorespiratory fitness. 
Cardiorespiratory and physical fitness depend 
on how much physical activity a 
person does. Physical activity ismovement 
bodyproduced by skeletal muscle contractions 
which increases energy expenditure beyond the 
energy used at rest, consisting of 
daily activities such as walking, 
housework, work at work and 
262 http: //jurnal.fk.unand .ac.id 
special activities that are indeed carried out to 
improve health. Recent findings 
show that physical activity in the form of 
aerobic exercise prevents blood pressure from increasing 
insulin sensitivity and functioning of thenervous system 
autonomic, in addition to physical activity in the form oftraining to 
resistanceprevent blood pressure from increasing blood 
vessel vasoconstriction. 
Housewives routinely carry outactivities 
physicalin the form of housework, but are not 
accompanied by special physical activities 
that can reduce blood pressure. Housewives 
who suffer from hypertension become more 
numerous so that more people suffer from 
hypertensive retinopathy. 
13 
Narrowing of arterioles is an early sign 
of hypertensive retinopathy. CHS (Cardiovascular 
Health Study) with 2405 samples showing the 
width of the arteriole will decrease with increasing 
systolic and diastolic blood pressure in 
men and women aged 69-79 years. The ARIC 
study shows a reduction in AVR within 
3-6 years if blood pressure persists or 
increases. Seen from MAP (mean arterial blood 
pressure), when MAP increases from 80 mmHg 
to 131 mmHg, CRAE will decrease 
constantly from 203 μm to 180 μm, but when 
MAP increases from 131 mmHg, CRAE will 
increase from 180 μm. The same thing happens to the 
CRVE, when MAP increases from 80 mmHg tommHg 
131, the CRVE will decrease constantly from 
230 μm to 220 μm, but when MAP 
increases from 131 mmHg, CRVE will increase 
from 220 mmHg. Arterioles and venules will narrow down 
with increasing blood pressure (until 
stage 1 hypertension) but will widen again 
if the blood pressure is too high (past 
stage 1 hypertension), soretinopathy 
that most hypertensivesufferers are those suffering 
from stage 1 hypertension followed by pre- 
hypertension, because in stage 2 hypertension, 
arterioles and venules no longer decrease, but instead 
widen. Prehypertension sufferers are patients 
who suffer from hypertension for a long time, but are 
controlled by hypertension drugs. 
10 
According to 
Andalas Health Journal. 2018; 7 (2) 
 
with a study conducted by Mondal et al in 
Bangladesh in 2017, with 384 samples, 
targeting more patientsretinopathy 
with hypertensivewith controlled blood pressure (54%) 
than uncontrolled blood pressure (46%). 
14 
In the table above thedistribution offound in 
frequencythe most hypertensive retinopathy was 
patients with KW II hypertensive retinopathy stage with 
pre-hypertensive stage hypertension and the 
least was KW II-III hypertensive retinopathy 
stage with stage hypertension 2. Research 
conducted in Bangladesh in 2017 
showed almost all patients suffered from 
KW I hypertension retinopathy, however, the association ofretinopathy 
hypertensiveand stage of hypertension was not examined in the 
study. 
14 
Research conducted in 
Mexico in 2013 also showed that almost 
all patients suffered fromhypertensive retinopathy 
stage 1. In the study,patients 
most hypertensive retinopathywere stadium KW II 
with pre-hypertension. In the patient's medical record 
, almost all sufferers had 
hypertension in the long term. old, but 
controlled by drugs. In accordance with 
research conducted in Bangladesh,stage 
hypertensive retinopathyis easier to develop in 
patients with controlled hypertension 
compared to those who are not controlled. 
14 
Research conducted by Henderson et al in 
2011 in the United States also showed 
that chronic hypertension can provide aeffect 
protectiveon the development ofretinopathy 
hypertensivecompared to acute hypertension (which is 
usually caused by acuteor 
hypertensionsecondary hypertension) which directly causes 
stage III hypertensive retinopathy IV. In this study 
, patients withhypertension retinopathy 
stage III-IVaged 16 years were younger 
than the overall patients and also suffering 
from secondary hypertension. 
16 
Research 
conducted at RSUP DR. M. Djamil also saw two out 
of three people withretinopathy 
stage IV hypertensivesuffer from stagehypertension 
two, which may be associated with 
acute hypertension or secondary hypertension. 
263 http://jurnal.fk.unand.ac.id 
The limitation of this study is that the number of 
samples is small and has not studied the history 
of acute or secondary hypertension from the 
history in the medical record. 
The results of the study of the characteristics ofpatients 
hypertensive retinopathywho came for treatment at 
Eye Polyclinic RSUP DR. M. Djamil, the 
most hypertensive retinopathy patients had 
hypertension for 1-5 years as many as 47 
people (63.5%) with an average of all 
suffering from hypertension for 5.5 years. Research 
conducted by Monalisa in 2013 atin 
H Adam Malik General HospitalMedan,retinopathy sufferers 
most hypertensivesuffered hypertension for 
5-10 years, namely 30 people (52.6%), 
while those suffering from hypertension <5 years 
were as many as 25 people (43, 9%). 
17 
The difference 
with the Monalisa study was due to a 
smaller sample size of 57 
samples, but there was no difference that was 
so far from suffering from hypertension for 
<5 years and for 5-10 years. Research in 
Bangladesh by Mondal, et al in 2017 
showed the same thing, that is,sufferers 
most hypertensive retinopathyhad hypertension 
for> 5 years (69.13%) with an average of 6.7 
years. 
14 
The difference in the results is because 
the number of patients in DR M. Djamil 
nevercontrol hypertension prior complaintretinopathy 
hypertensiveappears, so just known 
to suffer from hypertension when first control to 
Poli's eyes, while research in Bangladesh 
was held in OPD (Out Patient 
Department ) at the Hypertension Research Center, 
so that the patient studied had found out 
he had suffered from hypertension before. Long 
suffering from hypertension is calculated from the first time the 
patient comes to RSUP DR. M. Djamil with or 
accompanied by hypertension, not from the results of ahistory 
complete, due to incompletedata 
history of theon the medical record. So, 
this can reduce the accuracy of the results of the 
study. According to other studies, nofound 
association wasfor suffering from hypertension with the 
incidence of hypertensive retinopathy, which was associated with 
the Andalas Health Journal. 2018; 7 (2) 
 
directly is increasing age with 
the incidence and severity ofretinopathy 
hypertensive. 
18 
Studies in Bangladesh also show 
the same thing, that the duration of hypertension 
does not affect the incidence and severity of 
hypertensive retinopathy. 
14 
Hypertension with poor control can 
cause cardiovascular, CNS,complications 
kidney and retinal. Hypertension will 
cause left ventricular hypertrophy which 
can lead to other cardiovascular diseases 
, such as myocardial ischemia, anddisease 
CNS, namely ischemic stroke. Therefore, it can be 
seen in the results of the study that inpatients 
hypertensive retinopathywho also suffer damage 
to the heart, not only suffer from one 
heart disease, but also suffer 
from other heart disease. From the data also found, 
that three patients with hypertensive retinopathy with 
heart damage, also suffer from ischemic stroke, 
this is a continuation of 
heart disease. The CRIC (Chronic Renal Insufficiency 
Cohort) study shows an association between the 
severity of hypertensive retinopathy and 
cardiovascular disease, furthermore, a study by 
NHANES I reported an increased 
risk of cardiovascular disease in patients with 
hypertensive retinopathy. 
18 
Retinal arterioles have 
similar anatomic structures (ie blood-barrier 
brain) and physiological functions (ie regulation ofpressure 
blood) with cerebral arterioles, so changes 
in the diameter of the retinal arterioles also reflect 
changes in the cerebral arterioles, changes in 
retinal arterioles can be used as predictions of 
abnormalities in SSP. 
18 
Studies conducted by 
Longstreth et al in 2007 also showed 
a clear association of arteriolar abnormalities 
due to hypertensive retinopathy (examined through 
fundoscopy) and clinical or subclinical strokes (examined 
by CT scan). 
19 
Retinal arterioles also have 
similarities with arterioles in the kidney, but are not 
anatomical equations and physiological functions, 
but similarities in the pathophysiological mechanism 
in the disease. 
18 
Studies conducted by 
Grundwald et al in 2012 in the United States 
264 http://jurnal.fk.unand.ac.id 
show that hypertensive retinopathy and 
chronic renal failure have similarities inchanges 
endothelial, namely thickening of the basement membrane,layer 
muscularand leakage. Narrowing of the retinal venules is 
also associated with a low GFR (glomerulous 
filtration rate). 
20 
This is supported by 
another study conducted by Shantha et al in 
South India in 2010 which concluded 
that hypertensive retinopathy in each stage 
has moderate accuracy as an indicator 
for predicting microalbuminuria. 
21 
The large 
number of hypertensive retinopathy patients without being followed by 
other target organ damage compared to 
hypertensive retinopathy patients followed byorgan damage 
othercan be due to other organ damage that 
has not been symptomatic, so that 
other organs are examined.reason 
Anotherthat causes patients with 
damage to other organs, already has many 
complications in its target organs so that 
many have died due to impaired heart function for 
the first time, thus increasing the 
risk of complications to other target organs. 
CONCLUSION 
Patients with hypertension retinopathy of almost 
half suffer from stage 1 
hypertension, more than half suffer fromsufferers 
hypertensive retinopathyof stage IIsufferers 
hypertension retinopathy, hypertensive retinopathymore than half have 
hypertension for 1-5 years,retinopathy sufferers 
more than half of hypertensivedo not have 
target organ damage other. 
REFERENCES 
1. Carretero OA, Oparil S. Essential hypertension part 
I: definition and etiology. Circulation. 2000; 101: 
329-35. 
2. Yogiantoro M. Clinical approach to hypertension. In: 
Setiati S, Alwi I, Sudoyo AW, Simadibrata M, 
Setiyohadi B, Syam AF, editor (editor). 
Textbookspathology in volume II. 6th edition. Jakarta: 
Interna Publishing; 2014.hlm.2259-82. 
Andalas Health Journal. 2018; 7 (2) 
 
3. World Health Organization (WHO). A global brief 
on hypertension: the silent killer. Global Public Health 
Crisis. 2013 Dec (downloaded October 1, 2017). 
Available from: http://apps.who.int/iris/bitstream/ 
10665/79059/1 / WHO_DCO_WHD_2013.2_eng.Ua 
Pdf?= 1 
4. Ministry of Health of the Republic of Indonesia (MOH). 
Hypertension. InfoDatin Data and Information 
Center of the Indonesian Ministry of Health: 2014 Jan (downloaded 
October 2017). Available from: 
http://www.depkes.go.id/resources/download/pusd 
atin / infodatin / infodatin-hipertensi.pdf7 
5. Indonesian Ministry of Health (MOH). Basicresearch 
healthin numbers (Riskesdas) 2013. 
Health Research and Development Agency of the 
Ministry of Republic of Indonesia; 2013 Jan (downloaded October 2017). 
Available from: 
http://www.depkes.go.id/resources/download/gener 
al / Results% 20Riskesdas% 202013.pdf 
6. Indonesian Ministry of Health (MOH). Basicresearch 
healthin numbers (Riskesdas). Agency for 
Health Research and Development 
Ministry of the Republic of Indonesia. West Sumatra Province. 2013 
Jan (downloaded October 2017). Available from: 
http://terbitan.litbang.depkes.go.id/penerbitan/index 
.php / lpb / catalog / book / 138 - Accessed October 2017 
7. Grosso A, Veglio F, Porta M, Grignolo FM, Wong 
TY . Hypertensive retinopathy revisited: some 
answers, more questions. Br J Ophthalmol. 
2005; 89: 1646–54. 
8. Bhargava M, Wong TY. Current concepts in 
hypertensive retinopathy: the retinal physician is 
often the first to detect it. Feb 2013 (downloaded 
October 2017). Available from: 
https://www.retinalphysician.com/issues/2013/nov- 
/ current-concepts-in-hypertensive-retinopathy 
9. Erden S, Bicakci E. Hypertensive retinopathy: 
incidence, risk factors, and comorbidities. clinical 
and experimental. Hypertension 2012; 34 (6): 397- 
401. 
10. Leung, Harry, Wang JJ, Rochtchina E, Tan AG, 
Wong TY, Klein R, et al. Relationship between age, 
blood pressure and retinal vessels in the 
older population. Invest Ophhalmol Vis Sci. 2003; 
44: 2900-4. 
265 http://jurnal.fk.unand.ac.id 
11. Burl VL, Whelton P, Roccella EJ, Brown C, Cutler 
JA, Higgins M, Horan MJ, Labarthe D. Prevalence 
of hypertension in the US adult population: results 
from the third national health and nutrition 
survey examination 1988-1991. Hypertension. 
1995; 25: 305–13. 
12. The Writing Group for the PEPI Trial. Effects of 
estrogen or estrogen / progestin regimens on heart 
disease risk factors in postmenopausal women: the 
postmenopausal estrogen / progestin inverventions 
(PEPI) trial. JAMA. 1995; 273: 1379-86. 
13. Diaz KM, Shimbo D. Physical activity and the 
prevention of hypertension. Curr Hypertens Rep. 
2013; 15 (6): 659–68. 
14. Mondal RN, Matin MA, Rani m, Hossain ZM, 
Shaha AC, Singh RB, et al. Prevalence and risk 
factors for hypertensive retinopathy in hypertensive 
patients. J Hypertens. 2017; 6: 241. 
15. Henderson DA, Blousse V, Newman NJ, Lamirel C, 
David WW, Bruce BB. Grade III or grade IV 
hypertensive retinopathy with severly elevated 
blood pressure. West J Emerg Med. 2012; 
13 (6): 529-34. 
16. Henderson DA, Blousse V, Newman NJ, Lamirel C, 
David WW, Bruce BB. Grade III or grade IV 
hypertensive retinopathy with severly elevated 
blood pressure. West J Emerg Med, 2012; 
13 (6): 529-34. 
17. Monalisa M. Characteristics ofretinopathy sufferers 
hypertensivewho come for treatment to the eye polyclinic of 
H. Adam Malik Hospital Medan in the period January 
2012-May 2013 (thesis). Medan: University 
of North Sumatra; 2013. 
18. Kabedi NN, Mwanza JC, Lepira FB, Kayembe TK, 
Kayembe DL. Hypertensive retinopathy and it's 
association with cardiovascular morbidity in 
congenital patients. Cardiovasc J Afr. 2014; 25: 
228-32. 
19. Longstreth WJr, Larsen EK, Klein R. Retinal 
microvascular abnormalities and MRI-defined 
subclinical cerebral infarction: the atherosclerosis 
risk in community study. Stroke. 2006; 37: 82-6. 
20. Grunwald JE, Alexander J, Ying GS, Maguire M, 
Daniel E, Martin RW, et al. Retinopathy and chronic 
kidney disease in the chronic renal insufficiency 
Andalas Health Journal. 2018; 7 (2) 
 
cohort (CRIC) study. Arch Ophthalmol. 2012; 
130 (9): 1136–44. 
21. Shantha GP, AA Kumar, Bhaskar E, Sivagnanam 
K, Srinivasan D. hypertensive retinal changes, a 
266 http://jurnal.fk.unand.ac.id 
screening tool to predict microalbuminuria in 
Hypertensive Patients: a cross sectional study. Nephrol 
Dial Transplant. 2010; (25): 1839-45. 
Andalas Health Journal. 2018; 7 (2)