Purchase this article with an account.
Amanda D. Henderson, Valérie Biousse, Nancy J. Newman, Cédric Lamirel, David W. Wright, Beau B. Bruce; Risk Factors for Grade III or IV Hypertensive Retinopathy in the Setting of Hypertensive Urgency. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3610.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Hypertensive retinopathy describes a spectrum of retinal vascular signs in patients with elevated blood pressure (BP). It is unknown why some patients are more likely to develop acute ocular end-organ damage than others with similar BP. We examined risk factors for grade III or IV hypertensive retinopathy among patients with hypertensive urgency in the emergency department (ED), and compared healthcare utilization and mortality between patients with and without grade III or IV hypertensive retinopathy.
Patients who presented to a university hospital ED with diastolic BP ≥120 mmHg were prospectively enrolled as part of the Fundus Photography vs. Ophthalmoscopy Trial Outcomes in the ED (FOTO-ED) study. Bilateral non-mydriatic fundus photographs, vital signs, and demographics were obtained at presentation. Past medical history, laboratory values, healthcare utilization, and mortality were ascertained from chart review at least 8 months after initial ED visit.
7/21 patients presenting with diastolic BP ≥120 mmHg (33%) had grade III or IV hypertensive retinopathy. Patients with retinopathy were significantly younger than those without (median 33 vs 50 years, p=0.02). Mean arterial pressure (165 vs 163 mmHg) was equal in the two groups. Patients with retinopathy had substantially increased, but non-significant, rates of ED revisit (57% vs 29%, p=0.35) and hospital admission after ED discharge (43% vs 14%, p=0.28). One of the patients with retinopathy died, whereas none without retinopathy died.
Accounting for BP differences, younger age appears to be a very strong risk factor for grade III or IV hypertensive retinopathy among patients with hypertensive urgency. This could be explained either because chronic compensatory mechanisms have not yet developed in these younger patients or because older patients with retinopathy are underrepresented due to increased mortality among these patients occurring at a younger age (survivorship bias).
This PDF is available to Subscribers Only