Synopsis
Use retinal vascular findings to distinguish chronic hypertension from acute organ injury, prioritise systemic assessment and avoid harmful uncontrolled blood-pressure reduction.
- Chronic arteriolar narrowing and crossing changes reflect vascular remodelling; they do not by themselves prove an acute hypertensive emergency.
- Haemorrhages, cotton-wool spots, exudation and disc swelling raise concern for more severe injury and should prompt measurement of systemic pressure.
- NICE requires same-day specialist assessment for severe hypertension accompanied by retinal haemorrhage or papilloedema.
Key red flags
Severely raised blood pressure with retinal haemorrhages, optic-disc swelling, confusion, chest pain, breathlessness or acute kidney injury requires same-day hospital assessment.
Investigation priorities
Confirm the scale of the pressure elevation while looking immediately for acute organ injury.
Management branches
A severe clinic pressure is accompanied by haemorrhage, disc swelling or symptoms of acute systemic injury.
- Arrange same-day medical specialist assessment and communicate the measured pressures, visual findings and accompanying symptoms directly.
- Evaluate neurological, renal and cardiac function while providing ophthalmic examination appropriate to the visual deficit.
Key medicines
Amlodipine for an agreed oral hypertension planIn an adult selected for oral treatment, the usual starting dose is 5 mg by mouth once daily, increasing according to response and tolerability to a maximum of 10 mg once daily. Continue as ongoing blood-pressure therapy with scheduled review; it is not an as-needed rescue dose for an isolated high reading.