Hypertensive Retinopathy

Question 1

Who commonly gets malignant hypertension

Answer 1

Young males

Question 2

Causes of malignant hypertension

Answer 2

Pheochromocytoma

Question 3

Treatment of malignant hypertension

Answer 3

Gradual reduction in blood pressure to minimise the risk of stroke

Question 4

Hypertensive retinopathy

Answer 4

Damage to the retinal small blood vessels relating to systemic hypertension either gradually due to chronic hypertension or acutely due to malignant hypertension

Question 5

Signs of hypertensive retinopathy

Answer 5

Silver wiring or copper wiring

Arteriovenous nipping

Cotton wool spots

Hard exudates are caused by damaged vessels leaking lipids into the retina.

Retinal haemorrhages

Papilloedema

Question 6

Silver wiring

Answer 6

Arteriole walls become thickened and sclerosed causing increased reflection of the light

Question 7

Arteriovenous nipping

Answer 7

Arterioles cause compression of the veins where they cross.

Due to sclerosis and hardening of the arterioles.

Question 8

How are cotton wool spots caused

Answer 8

Due to ischaemia and infarction in the retina causing damage to nerve fibres

Question 9

Hard exudates

Answer 9

Damaged vessels leaking lipids into the retina

Question 10

Retinal heamorrhages

Answer 10

Caused by damaged vessels rupturing and releasing blood into the retina

Question 11

Papilloedema

Answer 11

Caused by ischaemia to the optic nerve resulting in optic nerve swelling (oedema) and blurring of the disc margins

Question 12

Keith-Wagener Classification

Answer 12

Stage 1: Mild narrowing of the arterioles

Stage 2: Focal constriction of blood vessels and AV nipping

Stage 3: Cotton-wool patches, exudates and haemorrhages

Stage 4: Papilloedema

Question 13

Management of hypertensive retinopathy

Answer 13

Tight blood pressure control:

• ACEi
• ARBs
• Beta blockers

Reduce modifiable risk factors:

• smoking cessation
• lipid levels - healthy diet and atorvastatin