Generality/Definition
Epidemiology
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Most commonly, the patient is middle age or older. In addition, hypertension is more common in African-Americans than Caucasians. Patients with only hypertensive retinopathy are nearly always visually asymptomatic.
Source: Hypertensive Retinopathy (revoptom.com)
Prevention
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High blood pressure can cause damage to blood vessels in the eyes. The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be. Your health care provider can see narrowing of blood vessels, and excess fluid oozing from blood vessels, with an instrument called an ophthalmoscope. The degree of retina damage (retinopathy) is graded on a scale of I to IV. Control of high blood pressure prevents changes in the blood vessels of the eye.
At grade I, no symptoms may be present. Grade IV hypertensive retinopathy includes swelling of the optic nerve and of the visual center of the retina (macula). Such swelling can cause decreased vision.
Source: MedlinePlus - Medical Encyclopedia: Hypertensive retinopathy (nlm.nih.gov)
Symptoms
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Patients with grade IV (severe hypertensive retinopathy) frequently also have heart and kidney complications of high blood pressure. The retina will generally recover well if the blood pressure is controlled, but some patients with grade IV hypertensive retinopathy will have permanent damage to the optic nerve or macula.
Source: MedlinePlus - Medical Encyclopedia: Hypertensive retinopathy (nlm.nih.gov)
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Signs and Symptoms The patient with hypertensive retinopathy, as expected, suffers from hypertension. However, the hypertension may be unknown to th e patient and the eye exam may yield the first clue to this relative asymptomatic systemic disease. Most commonly, the patient is middle age or older. In addition, hypertension is more common in African-Americans than Caucasians. Patients with only hypertensive retinopathy are nearly always visually asymptomatic. Findings in hypertensive retinopathy include cotton wool spots and flame shaped hemorrhages. Only rarely will there be retinal or macular edema. In advanced cases, there will be a macular star (ring of exudates from the disc to the macula) and disc edema. Arteriolosclerosis (arteriolar narrowing, arterio-venous crossing changes with venous constriction and banking, arteriolar color changes, vessel sclerosis) is often found concurrently.
Source: Hypertensive Retinopathy (revoptom.com)
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The ophthalmologist may see narrowing of the vessels in the retina, retinal hemorrhages and other signs of hypertension including ischemic (poor blood flow) areas and swelling.
Patients with swelling of the optic nerve may have malignant hypertension, a severe form of high blood pressure with a diastolic (lower number) reading of 120 to 130 mm Hg or more. This condition usually requires immediate hospitalization and an evaluation for the underlying cause of the hypertension.
Source: Eye Conditions > Hypertensive Retinopathy- EyeMDLink.com (eyemdlink.com)
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Treatment
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Management of hypertensive retinopathy involves appropriate treatment of the underlying hypertension. Medical co-management with the primary physician is of paramount importance. However, if a patient presents with papilledema from hypertension, then the patient has malignant hypertension and should be considered to be in medical crisis. This patient needs immediate consult with a primary care physician and, most likely, immediate transport to a hospital emergency room. It must be reiterated, however, that there are many causes of papilledema. Other causes of papilledema, such as an intracranial mass lesion, must also be considered in the patient with hypertension. However, in a case where blood pressure is extremely elevated (e.g. 250/150mmHg) and there is disc edema with a macular star, malignant hypertension is the likely cause.
Source: Hypertensive Retinopathy (revoptom.com)
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Information for specialists
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This study provides precise estimates of the prevalence of retinal lesions in nondiabetic persons with and without hypertension. The findings suggest that retinopathy (6% in normotensives and 11% in people with hypertension), and retinal arteriolar narrowing (11% in normotensives and 19% in people with hypertension) are common. Further longitudinal study is necessary to evaluate the public health significance of these findings.
Source: Blood pressure, hypertension and retinopathy in a population. (pubmedcentral.nih.gov)
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A 34-year-old woman presented with a short history of headache and blurred vision. Her corrected visual acuity was 20/30 and N24 in the left eye and 20/20 and N5 in the right; her blood pressure was 240/150 mm Hg. Funduscopic examination revealed grade IV hypertensive retinopathy, with widespread hemorrhages (Panel A, HEM), soft and hard exudates (SE, HE), and swelling of the optic disc (OD). Renal function was impaired, with a blood urea nitrogen concentration of 31 mg per deciliter (11.2 mmol per liter) and a serum creatinine concentration of 3.4 mg per deciliter (298 mol per liter). Accelerated hypertension was diagnosed. The results of renal angiography, screening renal autoantibody, and urine metanephrine and normetanephrine concentrations were normal. Ten months later, after treatment with a combination of irbesartan, atenolol, and amlodipine, the patient's blood pressure was 110/70 mm Hg. Renal function was stable, with a creatinine concentration of 2.0 mg per deciliter (174 mol per liter). Serial photographs of the retina demonstrated a progressive improvement in the hypertensive retinopathy (Panels B and C) after the successful treatment of the patient's elevated blood pressure.
Source: NEJM -- Improvement in Hypertensive Retinopathy after Treatment of Hypertension (content.nejm.org)
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Scientific articles:
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Clinical trials for "Hypertension":
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