Retinal Detachment in Malignant Hypertension

A 37-year-old woman with no previous medical conditions presented with a 3-day history of headache and blurry vision. Her blood pressure was elevated, at 220/150 mm Hg, and visual acuity in both eyes was such that she could count fingers only and had sluggish pupil reactivity. Retinal examination revealed bilateral disk swelling with scattered cotton-wool spots (Panel A, arrow) and bilateral inferior serous retinal detachment (Panel B, arrow). Further workup revealed that the patient had renal disease, with a serum creatinine level of 14.9 mg per deciliter (1320 μmol per liter). She was treated with isosorbide dinitrate and amlodipine in . . .