Hypertension and hypertensive retinopathy

Question 1

What is considered a normal blood pressure reading?

Answer 1

120/80mmHg

Question 2

What is considered a hypotensive blood pressure reading?

Answer 2

90/60mmHg

Question 3

What is considered a hypertensive blood pressure reading?

Answer 3

140/90mmHg

Question 4

What is considered a severely hypertensive blood pressure reading?

Answer 4

180/120mmHg

Question 5

What are some common hypertensive medications?

Answer 5

Ramipril
Amlodipine
Timolol
Losartan

Question 6

What can cause secondary hypertension?

Answer 6

Renal disease
Endocrine disease
Congenital coarctation of aorta

Question 7

What are the risk factors for hypertension?

Answer 7

Unhealthy diet
Smoking
Lack of exercise
Alcohol
Obesity
Diabetes
Increased age
Ethnicity (South Asian, African, Caribbean)
FH vascular disease
Raised blood lipids

Question 8

What are the symptoms of hypertension?

Answer 8

Often none
Throbbing HAs
Shortness of breath
Palpitations
Dizziness
Fatigue
Nose bleeds

Question 9

What are the ocular signs of hypertension?

Answer 9

Hypertensive retinopathy
Choroidopathy
Disc oedema
AION
Artery/vein occlusions
Macro-aneurysm/retinal emboli
Ocular motor nerve palsy
Glaucomatous optic neuropathy

Question 10

What are the non-pharmacological treatments for hypertension?

Answer 10

Stop smoking
Reduce alcohol intake
Reduce salt intake
Reduce caffeine intake
Weight reduction
Regular exercise
Improve diet

Question 11

What do ACE inhibitors do?

Answer 11

Stops vessel constriction (e.g. ramipril)

Question 12

What do angiotensin receptor blockers do?

Answer 12

Stops vessel constriction
Reduces fluid levels
(e.g. losartan)

Question 13

What do calcium channel blockers do?

Answer 13

Cause vasodilation
(e.g. amlopodine)

Question 14

What do diuretics do?

Answer 14

Increase sodium and water removal in kidneys
Reduces fluid levels
(e.g. bendroflumethiazide)

Question 15

What other less common pharmacological treatments for hypertension are available?

Answer 15

Beta blockers
Alpha blockers
Alpha-adrenergic agonists
Direct renin inhibitors

Question 16

What are the stages of hypertensive retinopathy?

Answer 16

Vasoconstrictive
Sclerotic
Exudative

Question 17

What occurs in vasoconstrictive HR?

Answer 17

General arteriolar narrowing

Question 18

What occurs in sclerotic HR?

Answer 18

Loss of muscle cells
Vessels become hyalinised (causes silver/copper wiring and crossing changes)
Aneurysms
CRAO/CRVO
ERM formation

Question 19

What occurs in the exudative phase of HR?

Answer 19

Blood/retina barrier disrupted (loss of smooth muscle and endothelial cells)
Haemorrhage
Oedema
CWS
Disc swelling

Question 20

What are the signs of mild HR?

Answer 20

Arterial opacification (silver/copper wiring)
Nipping/narrowing of vessels (AV nipping)

Question 21

What are the signs of moderate HR?

Answer 21

Mild +
Flame/blot haem
Microaneurysms
CWS
Hard exudates/macular star

Question 22

What are the signs of severe HR?

Answer 22

Moderate +
disc swelling

Question 23

How should mild hypertensive retinopathy be managed?

Answer 23

Refer to GP if undiagnosed

Question 24

How should moderate HR be managed?

Answer 24

Refer to GP
Refer to HES if visual symptoms, diabetic or vascular complications

Question 25

How should severe HR be managed?

Answer 25

Same day referral to HES A&E if BP > 180/120mmHg

Question 26

What are focal intraretinal periarteriole transudates (FIPTs)?

Answer 26

Round/oval white lesions (<1/4 DD) caused by plasma macromolecules along deep arterioles Only present in HR

Question 27

What is Gunn's sign?

Answer 27

Hardened artery blanches vein or forces vein elevation

Question 28

What is Salus' sign?

Answer 28

Hardened artery causes vein deviation

Question 29

What is Bonnet's sign?

Answer 29

Hardened artery presses on vein, causing differing vessel size on either side of artery

Question 30

What is grade 1 of the Keith-Wagener-Barker classification of HR?

Answer 30

Mild artery narrowing

Question 31

What is grade 2 of the Keith-Wagener-Barker classification of HR?

Answer 31

Tighter constrictions of artery (AV nipping)

Question 32

What is grade 3 of the Keith-Wagener-Barker classification of HR?

Answer 32

Grade 2 + Retinal oedema CWS Microaneurysms Haem

Question 33

What is grade 4 of the Keith-Wagener-Barker classification of HR?

Answer 33

Grade 3 + Optic disc swelling Macular oedema

Question 34

What is grade 1 of the Scheie classification of arteriosclerotic retinopathy?

Answer 34

Artery narrowing Brighter arteriole light reflex

Question 35

What is grade 2 of the Scheie classification of arteriosclerotic retinopathy?

Answer 35

Grade 1 + Salus' sign

Question 36

What is grade 3 of the Scheie classification of arteriosclerotic retinopathy?

Answer 36

Grade 2 + Copper wiring Bonnet's sign Gunn's sign

Question 37

What is grade 1 of the Scheie classification of arteriosclerotic retinopathy?

Answer 37

Grade 3 + Silver wiring

Question 38

What are the signs of hypertensive choroidopathy?

Answer 38

RPE lesions (Elschnig's spots) Siegrists streaks

Question 39

What causes disc swelling in HR?

Answer 39

Raised ICP Disc ischaemia AION