Blood Pressure Threshold for Abnormal Ocular Fundus Findings Is Lower Than Expected

Abstract

To the Editor: 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.1 Indeed, the presence or absence of severe, grade III/IV hypertensive retinopathy helps differentiate hypertensive emergencies requiring intensive care from less severe hypertensive urgencies.1 As a secondary analysis in the Fundus photography versus Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study,2,3 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. Three hundred fifty adult patients presenting to the Emory University ED with a chief complaint of headache, acute focal neurological deficit, visual changes, or a diastolic BP (DBP) ≥120 were prospectively enrolled during the FOTO-ED study (ClinicalTrials.gov NCT00873613) from March 2009 and January 2010. Photographs of the ocular fundus (optic disc and macula) were obtained from both eyes, using a commercially available nonmydriatic ocular fundus camera (Kowa α-D, Torrence, CA) by nurse practitioners on eligible patients between 7 am and 10 pm …