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Retinal changes in malignant hypertension.

E McGregor, C G Isles, J L Jay

    British Medical Journal (Clinical Research Ed.)
    |January 25, 1986
    PubMed
    Summary
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    Papilloedema is an unreliable sign in malignant hypertension and does not impact survival in patients with retinal hemorrhages and exudates. Effective treatment means papilledema is no longer a necessary feature.

    Area of Science:

    • Ophthalmology
    • Cardiology
    • Nephrology

    Background:

    • Malignant hypertension is a severe condition characterized by hypertensive retinopathy.
    • Papilloedema, retinal hemorrhages, and exudates are key signs of hypertensive retinopathy.
    • The diagnostic and prognostic significance of papilloedema in this context requires clarification.

    Purpose of the Study:

    • To evaluate the diagnostic reliability of papilloedema among observers.
    • To assess the prognostic value of papilloedema in patients with malignant hypertension.
    • To determine if papilloedema influences survival rates in hypertensive retinopathy.

    Main Methods:

    • A two-part study involving photographic review and survival analysis.
    • Four observers assessed 56 fundus photographs for hemorrhages, exudates, and papilloedema.

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  • Survival of 139 hypertensive patients with retinal findings was analyzed using life tables and multivariate analysis.

    • Main Results:

    • Observer agreement was high for hemorrhages (52/56) and exudates (53/56), but low for papilloedema (34/56).
    • Ten-year survival rates were similar for patients with hemorrhages and exudates alone (46%) versus those with added papilloedema (48%).
    • Multivariate analysis indicated no significant relationship between papilloedema and survival.

    Conclusions:

    • Papilloedema is an unreliable diagnostic sign in malignant hypertension due to low inter-observer agreement.
    • Papilloedema does not adversely affect prognosis in patients with existing retinal hemorrhages and exudates, especially with effective treatment.
    • Papilloedema should not be considered a mandatory criterion for diagnosing malignant hypertension.