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August 1960

The Course of Retinopathy in Treated Malignant Hypertension

Author Affiliations

Canton, Ohio; Iowa City; Cleveland

From the Department of Ophthalmology and the Research Division of the Cleveland Clinic Foundation and the Frank E. Bunts Educational Institute.

Arch Intern Med. 1960;106(2):205-212. doi:10.1001/archinte.1960.03820020045007

The concurrent development of papilledema, retinal hemorrhages, and exudates in the course of hypertensive disease is regarded as a cardinal sign of necrotizing arteriolar disease (accelerated or malignant hypertension). Hence, these retinal signs have serious prognostic significance.1 In recent years, effective antihypertensive treatment has improved the immediate prognosis of malignant hypertension; with adequate blood-pressure control, papilledema, retinal hemorrhages, and exudates disappear and extraretinal signs of progressive hypertensive vascular disease remit.

The purpose of this report is to review the retinal abnormalities of patients with malignant hypertension with regard to their prognostic significance; to describe the effect of antipressor therapy on these abnormalities, and to show the association of the retinal changes with the effects of treatment on the extraretinal manifestations of the disease.

Methods and Material 

Patients Studied.  —The group was composed of 96 patients with apparent "primary" or "essential" hypertension in the malignant phase; all but one had