Ophthalmological Investigations of 500 Persons with Hypertension of Long Duration

FOR many years it has been an established fact that severe changes in the retina, i.e., haemorrhages, exudates, and papilloedema (" retinitis albuminurica ") indicate a bad prognosis in patients suffering from hypertension, but the slighter changes have only attracted attention during recent years. Wagener and Keith (1939) proposed a classification of hypertension into four groups according to the changes in the retina. This classification has many supporters amongst both ophthalmologists and physicians, although their first two groups were based on only 36 patients, whereas Groups 3 and 4 contained 180 patients. Their material appears, in fact, to have been very selected; it consisted almost entirely of patients with the most severe degrees of hypertension, many having nephrosclerosis or malignant hypertension. Undoubtedly, as the authors themselves stressed, this material gives a false impression of the frequency of the different degrees of retinal changes in hypertension. Bechgaard has shown that malignant hypertension probably does not make up more than 1 per cent. of all cases with this condition. Wagener and Keith's work on the ophthalmoscopic appearances in patients with hypertension aroused considerable interest, and it was expected that pathological changes in the retina would be present in a large number of the patients. However, retinal changes can only be found with similar frequency in hospitals and clinics where a large number of true malignant cases of hypertension are investigated. It is therefore interesting to determine the frequency with which retinal changes appear in more representative series of cases with hypertension. It would have been particularly interesting, if our cases had also been investigated ophthalmoscopically, when the hypertension was first diagnosed, but only patients with hypertension of long duration have been studied here. Therefore malignant cases and cases of short duration are automatically excluded. In this respect the material differs entirely from that of Wagener and