Retinal changes depend on factors such as the level of the blood pressure and the state of the arterioles. The primary response to hypertension is arteriolar spasm and narrowing. This can occur more readily in younger patients with no sclerotic protection of their arterioles.
Patients with essential hypertension and elderly normotensives develop compensatory arterial changes such as silver wiring and AV nipping. Retinal haemorrhages are unusual and suggest an associated retinal vascular accident.
Cotton wool spots, flame haemorrhages and disc swelling are more typical of malignant hypertension especially in young patients.