Disc Swelling in Systemic Hypertension

The presence of optic disc edema in malignant hypertensions well known and has been described as indicating a poor prognosis. This is because Keith et al, in 1939 found a mean survival period of only 4 1/2 months in such patients, and Kincaid-Smith et al.2 in 1958 found 50% of the untreated patients in this category dead within two months and 90% within a year. Thus, the presence or absence of optic disc edema has been thought of great clinical importance in the evaluation of the patient with malignant hypertension, and its presence was considered an ominous sign. However, in 1986, McGregor et al, in 96 consecutive patients with hypertensive retinopathy and optic disc edema, on multivariate analysis, found that optic disc edema was not related to survival, and concluded that optic disc edema is an unreliable physical sign and does not adversely influence prognosis in hypertensive patients. They further advocated that optic disc edema should no longer be regarded as a necessary feature of malignant hypertension. I agree with that. This change may represent a tremendous advance in the understanding of the pathophysiology and treatment of malignant hypertension during the past half century.