Hypertensive retinopathy (2023)

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The retina is the layer of tissue at the back of your eye. This layer converts light into nerve signals that are then sent to the brain for interpretation.

When your blood pressure is too high, the walls of the retinal blood vessels can become thicker. This can cause your blood vessels to narrow, preventing blood from reaching the retina. In some cases, the retina swells.

Over time, high blood pressure can damage the blood vessels in the retina, restrict the function of the retina, and put pressure on the optic nerve, causing vision problems. This condition is called hypertensive retinopathy (HR).

You probably won't have symptoms until the condition is very advanced. Possible signs and symptoms include:

  • impaired vision
  • swelling of the eyes
  • burst blood vessel
  • double vision accompanied by headache

Get medical help right away if your blood pressure is high and you have sudden changes in your vision.

Long-term high blood pressure, or hypertension, is the main cause of HR. High blood pressure is a chronic problem where the force of the blood in your arteries is too high.

The force is a result of blood being pumped out of the heart and into the arteries, as well as the force created when the heart contracts between heartbeats.

As blood moves through the body at higher pressure, the tissue that makes up the arteries will begin to stretch and eventually be damaged. This leads to many problems over time.

HR generally occurs after your blood pressure has been consistently high for a long time. Your blood pressure level can be affected by:

  • lack of physical activity
  • be overweight
  • eat a lot of salt
  • a stressful lifestyle

High blood pressure also runs in families.

In the United States, high blood pressure is quite common. AccordingThe Food and Drug Administration (FDA),the condition affects 1 in 3 adults in the United States. It is called the "silent killer" because it usually has no symptoms.

The following conditions put you at higher risk for HR:

  • long-term high blood pressure
  • heart disease
  • atherosclerosis
  • Diabetes
  • smoking
  • high cholesterol
  • be overweight
  • eating an unhealthy diet that is high in fatty proteins, trans fats, sugary foods, and sodium
  • heavy alcohol consumption

In addition, the condition is more common in people of African descent, especially Afro-Caribbean people, according to2003 survey. Women are also more likely to be affected by blood vessel damage than men.


Your doctor will use a tool called an ophthalmoscope to examine your retina.

This tool shines a light through your pupil to examine the back of your eye for signs of narrowing blood vessels or to see if fluid is leaking from your blood vessels. This procedure is painless. It takes less than 10 minutes to complete.

Fluorescein angiography

In some cases, a special test called a fluorescein angiogram is done to look at the blood flow in the retina. In this procedure, your doctor will apply special eye drops to dilate your pupils and then take pictures of your eye.

After the first round of images, your doctor will inject a dye called fluorescein into a vein. They usually do this on the inside of the elbow. They will then take more pictures as the dye moves into the blood vessels in your eye.

The extent and severity of retinopathy is generally represented on a scale of 1 to 4. The scale is called the Keith-Wagener-Barker Classification System. The four grades increase in difficulty:

  • In category 1, there is a mild narrowing of the retinal artery.
  • Grade 2 is similar to grade 1, but there are more severe or tighter retinal artery stenosis. This is called the arteriovenous, or AV, notch.
  • Grade 3 has grade 2 signs, but there are also retinal edema, microaneurysms, cotton wool spots (fluffy white lesions on the retina), and retinal hemorrhages (bleeding).
  • Grade 4 has severe grade 3 signs, along with swelling of the optic disc called papilledema and macular edema. People with grade 4 retinopathy have a higher risk of stroke and may have kidney or heart disease.

At the low end of the scale, you may have no symptoms. At grade 4, however, your optic nerve can begin to swell and cause more severe vision problems. High-grade retinopathy tends to indicate serious blood pressure concerns.

People with HR are at risk of developing retina-related complications. These include the following:

  • Ischemic optic neuropathy, which occurs when high blood pressure blocks normal blood flow to the eyes, damaging the optic nerve. The optic nerve carries images of what we see to the brain.
  • Retinal artery occlusion, which occurs when the arteries that carry blood to the retina become blocked by blood clots. When this happens, the retina does not receive enough oxygen or blood. This results in vision loss.
  • Retinal vein occlusion, which occurs when the veins that carry blood away from the retina become blocked by blood clots.
  • Nerve fiber layer ischemia, or damage to nerve fibers, which can lead to papules or soft white lesions on the retina.
  • Malignant hypertension, which is a rare condition that causes blood pressure to rise sharply, obstructing vision and causing sudden vision loss. This is a potentially life-threatening condition.

People with HR also have an increased risk of having a stroke or heart attack. AResearch 2013of 2,907 people between the ages of 50 and 73 found that those with HR were more likely to have a stroke compared to those without the condition.

This was true even in people with blood pressure controlled by treatment. AResearch 20085,500 people between the ages of 25 and 74 showed an increased risk of stroke or cardiovascular disease in people with HR.

Effective treatment of HR involves controlling and lowering high blood pressure with a combination of medications and lifestyle changes.

Lifestyle changes

A diet rich in fruits and vegetables can help lower blood pressure. Regular physical activity, reducing salt intake and limiting the amount of caffeine and alcohol you drink can all contribute to healthy blood pressure.

If you smoke, take steps to quit. If you are overweight, your doctor may recommend losing weight as a strategy to control high blood pressure.


Your doctor may prescribe blood pressure medications, such as diuretics, beta-blockers, or ACE inhibitors.

You can control this condition by checking your blood pressure. If your condition is severe, however, you may have irreversible eye damage that causes permanent vision problems.

Prognosis is worse for higher HY grades. Grades 3 and 4 are associated with higher rates:

  • slag
  • heart attack
  • congestive heart failure
  • death

People with uncontrolled hypertension and grade 4 HR, sometimes called malignant stage, generally have a poor prognosis for survival, according to the journalRetina doctor.

Structural changes in the retinal arteries are generally not reversible. Even with treatment, patients diagnosed with HR have a higher risk of retinal artery and vein occlusion and other retinal problems.

If you have high blood pressure or HY, your primary care doctor can work with your ophthalmologist (ophthalmologist) to determine an appropriate treatment plan and monitor your condition.

To prevent HR, take steps to avoid high blood pressure. Here are some things you can do:

  • You take your blood pressure medicine regularly.
  • Exercise regularly.
  • Eat a balanced diet.
  • Avoid smoking.
  • Get regular medical checkups to make sure your blood pressure readings are normal.


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