Blood Pressure Threshold for Abnormal Ocular Fundus Findings is Lower than Expected

• Type of Material: Article
• Authors: Beau Benjamin Bruce, Emory University; Cedric Lamirel, Emory University; David W Wright, Emory University; Valerie Biousse, Emory University; Nancy J Newman, Emory University
• Language: English
• Date: 2012-02
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 American Heart Association, Inc.
• Final Published Version (URL): http://hyper.ahajournals.org/content/59/2/e8
• Title of Journal or Parent Work: Hypertension
• ISSN: 0194-911X
• Volume: 59
• Issue: 2
• Start Page: e8
• End Page: e9
• Grant/Funding Information: This study was supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by NIH/NEI core grant P30-EY06360 (Department of Ophthalmology). Dr. Bruce received research support from the NIH/PHS (KL2-RR025009, UL1-RR025008), NIH/NEI (K23-EY019341), and the Knights Templar Eye Foundation; and received the American Academy of Neurology Practice Research Fellowship. Dr. Lamirel received research support from Institut Servier (Paris, France), Fondation Planiol (Varennes, France), and the Philippe Foundation, Inc. (New York, NY). Dr. Wright received research support from NIH/PHS (KL2-RR025009). Dr. Biousse received research support from NIH/PHS (UL1-RR025008). Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award.
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Opthamology

Abstract

Ocular fundus examination is a critical part of the physical examination in patients with severely elevated blood pressure (BP), which is defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) as a BP exceeding 180/120 mm Hg. Indeed, the presence or absence of severe, grade III/IV hypertensive retinopathy helps differentiate hypertensive emergencies requiring intensive care from less severe hypertensive urgencies. As a secondary analysis in the Fundus photography versus Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study, we sought to explore potential risk factors, in particular BP, for the presence of ocular fundus abnormalities relevant to the care of emergency department (ED) patients. We found evidence of acute end-organ ocular damage at lower blood pressures than the JNC7 criteria.