Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure
Introduction: Hypertensive retinopathy describes a spectrum of retinal changes 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/IV hypertensive r...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2012-12-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/8600p503 |
| _version_ | 1818560871324975104 |
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| author | Amanda D Henderson Valérie Biousse Nancy J Newman Cédric Lamirel David W Wright Beau B Bruce |
| author_facet | Amanda D Henderson Valérie Biousse Nancy J Newman Cédric Lamirel David W Wright Beau B Bruce |
| author_sort | Amanda D Henderson |
| collection | DOAJ |
| description | Introduction: Hypertensive retinopathy describes a spectrum of retinal changes 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/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/IV hypertensive retinopathy.Methods: A preplanned subanalysis of patients who presented to a university hospital ED with diastolic BP > 120 mmHg and who enrolled in the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the ED study was performed. Bilateral nonmydriatic ocular fundus photographs, vital signs, and demographics were obtained at presentation. Past medical history, laboratory values, healthcare utilization, and mortality were ascertained from medical record review at least 8 months after initial ED visit.Results: Twenty-one patients with diastolic BP > 120 mmHg, 7 of whom (33%) had grade III/IV hypertensive retinopathy, were included. 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 essentially equal in the 2 groups. Patients with retinopathy had substantially increased but nonsignificant 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, but none without.Conclusion: Younger patients may be at higher risk for grade III/IV hypertensive retinopathy among patients with hypertensive urgency. Chronic compensatory mechanisms may have not yet developed in these younger patients. Alternatively, older patients with retinopathy may be underrepresented secondary to increased mortality among these patients at a younger age (survivorship bias). Further research is needed to validate these preliminary findings |
| first_indexed | 2024-12-14T00:43:49Z |
| format | Article |
| id | doaj.art-3b389f68a350454d988dfdf85d48ddf5 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-14T00:43:49Z |
| publishDate | 2012-12-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-3b389f68a350454d988dfdf85d48ddf52022-12-21T23:24:13ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182012-12-01136529534Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood PressureAmanda D HendersonValérie BiousseNancy J NewmanCédric LamirelDavid W WrightBeau B BruceIntroduction: Hypertensive retinopathy describes a spectrum of retinal changes 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/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/IV hypertensive retinopathy.Methods: A preplanned subanalysis of patients who presented to a university hospital ED with diastolic BP > 120 mmHg and who enrolled in the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the ED study was performed. Bilateral nonmydriatic ocular fundus photographs, vital signs, and demographics were obtained at presentation. Past medical history, laboratory values, healthcare utilization, and mortality were ascertained from medical record review at least 8 months after initial ED visit.Results: Twenty-one patients with diastolic BP > 120 mmHg, 7 of whom (33%) had grade III/IV hypertensive retinopathy, were included. 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 essentially equal in the 2 groups. Patients with retinopathy had substantially increased but nonsignificant 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, but none without.Conclusion: Younger patients may be at higher risk for grade III/IV hypertensive retinopathy among patients with hypertensive urgency. Chronic compensatory mechanisms may have not yet developed in these younger patients. Alternatively, older patients with retinopathy may be underrepresented secondary to increased mortality among these patients at a younger age (survivorship bias). Further research is needed to validate these preliminary findingshttp://escholarship.org/uc/item/8600p503Emergency medicineopthalmologyhypertensiveretinopathy |
| spellingShingle | Amanda D Henderson Valérie Biousse Nancy J Newman Cédric Lamirel David W Wright Beau B Bruce Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure Western Journal of Emergency Medicine Emergency medicine opthalmology hypertensive retinopathy |
| title | Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure |
| title_full | Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure |
| title_fullStr | Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure |
| title_full_unstemmed | Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure |
| title_short | Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure |
| title_sort | grade iii or grade iv hypertensive retinopathy with severely elevated blood pressure |
| topic | Emergency medicine opthalmology hypertensive retinopathy |
| url | http://escholarship.org/uc/item/8600p503 |
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