What type of hypertension can be associated with cotton wool spots in the retina?

Cotton wool spots in the retina are associated with areas of retinal ischemia and can indicate underlying vascular issues. In the context of hypertension, malignant hypertension is characterized by severely elevated blood pressure levels, often exceeding 180/120 mmHg, alongside evidence of end-organ damage, which includes changes in the retina such as cotton wool spots.

Malignant hypertension leads to endothelial damage and increased vascular permeability, causing retinal changes, including exudates and cotton wool spots. This condition can develop rapidly and is often a medical emergency due to the risk of significant complications, including vision loss and other organ failures.

In contrast, essential hypertension, while it can cause retinal changes over time, typically does not present with the acute and severe manifestations seen in malignant hypertension. Secondary hypertension may also contribute to retinal changes but does not inherently imply the degree of severity or immediate risk associated with malignant hypertension. Normal pressure refers to levels of blood pressure that are within a healthy range and would not be associated with the complications of significant retinal damage.