Hypertensive Retinopathy in Severely Hypertensive Children: Demographic, Clinical, and Ophthalmoscopic Findings From a 30-Year British Cohort

Purpose: There is scarce data regarding the incidence and clinical features of hypertensive retinopathy in children. The authors studied a large British cohort of severely hypertensive children to ascertain who developed hypertensive retinopathy, the severity, and the visual prognosis.

Methods: A retrospective review was performed of children undergoing renal angiography for investigation of severe hypertension at a tertiary institution from 1980 to 2010. All relevant cardiovascular, radiologic, and ophthalmic information was collected from case notes of the children identified in the study period. The outcome measures were presenting blood pressure, presence/severity of hypertensive retinopathy, and visual outcome.

Results: Fifty-three severely hypertensive children were identified; 30 with renovascular disease (RVD+) and 23 without (RVD-). The majority had 'stage 2 hypertension.' There were no significant differences in age, gender, or blood pressure between RVD+ and RVD- children. Seven (18%) of the 39 children receiving ophthalmic assessment had hypertensive retinopathy, of whom 6 had severe disease (retinal hemorrhages, exudates, and optic disc edema). There was a trend toward a higher prevalence of hypertensive retinopathy in the RVD+ group (n = 5) but this was not statistically significant. Children with hypertensive retinopathy had higher blood pressure than those without (median: 216/158 vs 150/98 mm Hg, P <.001).

Conclusions: This is the first study examining the incidence and characteristics of hypertensive retinopathy in British children with severe hypertension. The authors found an 18% incidence of hypertensive retinopathy, in some cases with permanent visual reduction.