From the Guidelines
Hypertensive crisis is strongly associated with ocular bleeding, as substantially elevated blood pressure can cause damage to the retina, leading to hemorrhages, cotton wool spots, and papilledema 1.
Key Findings
- Malignant hypertension, a severe form of hypertensive crisis, is characterized by advanced bilateral retinopathy, including hemorrhages, cotton wool spots, and papilledema 1.
- The development of acute hypertensive microangiopathy is preceded by an increase in renal vasoconstriction and microvascular damage, leading to activation of the renin–angiotensin system, which can cause ocular damage 1.
- Hypertensive encephalopathy, a complication of malignant hypertension, can present with visual impairment, including cortical blindness, and is associated with advanced hypertensive retinopathy 1.
- The management of hypertensive emergencies, including those with ocular involvement, requires immediate and careful blood pressure reduction, with the goal of preventing progressive organ failure 1.
Clinical Implications
- Patients with hypertensive crisis and ocular bleeding require prompt diagnosis and treatment to prevent permanent vision loss and other complications 1.
- The choice of antihypertensive treatment should be determined by the type of organ damage, including ocular involvement, and the severity of the hypertension 1.
- Oral medication can be used to manage malignant hypertension if blood pressure is responsive, with the goal of bringing diastolic blood pressure down to 100–110 mmHg over 24 hours 1.
From the Research
Relationship between Hypertensive Crisis and Ocular Bleeding
The relationship between hypertensive crisis and ocular bleeding is complex and multifaceted. Key points to consider include:
- Hypertensive crisis can lead to sudden changes in vision, which may be a medical emergency requiring immediate evaluation to rule out conditions such as systemic vasculitis or ischemic stroke 2.
- Hypertensive retinopathy, a condition characterized by retinal microvascular changes, is a common manifestation of hypertensive eye disease and can include signs such as retinal hemorrhages, microaneurysms, and optic disc edema 3, 4, 5.
- Ocular bleeding, including retinal hemorrhages, can be a consequence of hypertensive crisis and is associated with other retinal disorders such as exudates and adrenal involvement 2.
- Hypertension is a major risk factor for the development and progression of diabetic retinopathy, and control of blood pressure has been shown to prevent visual loss from diabetic retinopathy 4, 5.
- The effects of sustained hypertension on the eye can be directly visible as hypertensive retinopathy and choroidopathy, reflecting a pathological process occurring throughout the body 6.
Key Findings
Some key findings from the studies include:
- Hypertensive retinopathy signs are commonly seen in the general adult population and are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events 3.
- Mild hypertensive retinopathy signs are common and seen in nearly 10% of the general adult non-diabetic population 4.
- Hypertension is a risk factor for a number of vision-threatening eye conditions, including retinal vascular occlusion, retinal macroaneurysm, and non-arteritic anterior ischemic optic neuropathy 6.