Department of Internal Medicine, Flevohospital, Almere, The Netherlands.
Department of Ophthalmology, Flevohospital, Almere, The Netherlands.
J Clin Hypertens (Greenwich). 2021 Jan;23(1):166-171. doi: 10.1111/jch.14064. Epub 2020 Oct 5.
According to international guidelines, patients with a suspected hypertensive emergency (HE) admitted to the emergency department (ED) should undergo comprehensive evaluation including funduscopic examination. However, funduscopy is not always readily available and little is known about the prevalence of retinopathy among these patients in the ED setting. In order to characterize patients who should undergo funduscopy, we studied the prevalence, characteristics and clinical outcome in patients with a suspected HE and retinopathy grade III/IV. We conducted a retrospective cohort study of consecutive patients with severe elevation of blood pressure (BP) admitted to the ED between 2012 and 2015. Patients with a systolic blood pressure (SBP) ≥180 mm Hg or diastolic blood pressure (DBP) ≥120 mm Hg at time of presentation were included. A total of 271 patients were included, of whom 18 (6.6%; 95%CI 3.9-10.5) had a HE. In 121 patients (44.6%; 95%CI 37.1-53.3), funduscopy was performed, of whom 17 (14.0%; 95%CI 8.2-22.5) had retinopathy grade III/IV. Mean SBP and DBP were significantly higher in patients with retinopathy (P < .001). However, retinopathy was also seen in patients with lower BP (SBP < 200 mm Hg and DBP < 120 mm Hg). No differences in other clinical characteristics, including visual disturbances, were found. One patient with retinopathy suffered an ischemic stroke after taking oral medication. The prevalence of retinopathy is high among examined patients. Except for higher BP, no clinical signs or symptoms are associated with the presence of retinopathy grade III/IV. We therefore conclude that funduscopic examination should be performed in every patient with a suspected HE.
根据国际指南，怀疑患有高血压急症（HE）并被收入急诊科（ED）的患者应进行全面评估，包括眼底检查。然而，眼底检查并不总是能够立即进行，对于 ED 环境中这些患者的视网膜病变的患病率知之甚少。为了确定应进行眼底检查的患者特征，我们研究了疑似 HE 合并视网膜病变 III/IV 级患者的患病率、特征和临床结局。我们对 2012 年至 2015 年间因严重血压升高（BP）被收入 ED 的连续患者进行了回顾性队列研究。纳入的患者在就诊时收缩压（SBP）≥180mmHg 或舒张压（DBP）≥120mmHg。共纳入 271 例患者，其中 18 例（6.6%；95%CI 3.9-10.5）患有 HE。在 121 例（44.6%；95%CI 37.1-53.3）患者中进行了眼底检查，其中 17 例（14.0%；95%CI 8.2-22.5）患有视网膜病变 III/IV 级。视网膜病变患者的平均 SBP 和 DBP 明显更高（P<.001）。然而，视网膜病变也见于血压较低的患者（SBP<200mmHg 和 DBP<120mmHg）。其他临床特征，包括视力障碍，无差异。1 例视网膜病变患者在服用口服药物后发生缺血性卒中。检查患者中视网膜病变的患病率较高。除了更高的 BP 外，没有其他临床症状或体征与 III/IV 级视网膜病变的存在相关。因此，我们得出结论，对于疑似 HE 的患者，应进行眼底检查。
