Clinical features and fundal findings in hypertension
THE CONTEXT
Hypertension is usually detected incidentally or after a complication, while examination may identify an underlying cause or evidence of organ damage.
Presentation and detection
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Hypertension is usually asymptomatic until detected during routine examination or when a complication develops.
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The source advises blood pressure checks every 5 years in adults over 40 years of age to detect occult hypertension.
Clues to underlying causes and risk factors
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Radio-femoral delay suggests coarctation of the aorta; enlarged kidneys suggest polycystic kidney disease.
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Abdominal bruits may suggest renal artery stenosis, while characteristic facies and habitus may indicate Cushing syndrome.
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Examination may reveal central obesity and hyperlipidaemia as risk factors.
Cardiovascular complications
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Examination may reveal left ventricular hypertrophy, an accentuated aortic component of the second heart sound and a fourth heart sound.
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Atrial fibrillation is common and may result from diastolic dysfunction caused by left ventricular hypertrophy or from coronary artery disease.
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Severe hypertension can cause left ventricular failure even without coronary artery disease, particularly when renal function is impaired.
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Generalised atheroma, aortic aneurysm, peripheral arterial disease or stroke may be evident.
Retinal findings
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Fundal changes vary with hypertension severity, and fundoscopy can indicate arteriolar damage elsewhere.
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Cotton wool exudates are associated with retinal ischaemia or infarction and fade within a few weeks.
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Hard exudates are small, white, dense lipid deposits. These and microaneurysms, described as dot haemorrhages, are more characteristic of diabetic retinopathy.
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Hypertension is also associated with central retinal vein thrombosis.