What is Hypertensive Retinopathy?

Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure. Hypertension (HTN) affects several systems such as the cardiovascular, renal, cerebrovascular, and retina, when not treated properly. A generalized response to systemic hypertension is vasoconstriction. This causes retinal vasculopathy in both acute and chronic stages of systemic hypertension. There has been significant evidence that hypertensive retinopathy acts as a predictor of systemic morbidity and mortality due to target-organ damage.
Hypertensive Retinopathy Pathogenesis
Vasospasm
Arteriosclerotic changes
Increased Vascular Permeability
Raised intracranial pressure

Causes

Chronic hypertension leads to arteriosclerotic changes in the blood vessels. Hypertension may be primary or essential for which there is no detectable cause.

Secondary hypertension may be caused by an underlying disease such as:

Primary hyperaldosteronism.

Cushing’s syndrome.

Pheochromocytoma.

Renal vascular or renal parenchymal disease.

Coarctation of the aorta.

Hyperthyroidism.

Hyperparathyroidism.

A major risk factor for essential hypertension is the severity of hypertension.

Signs and Symptoms:

Most patients with hypertensive retinopathy have no symptoms. However, some may report decreased or blurred vision, and headaches. Signs of damage to the retina caused by hypertension include:
Arteriolar changes, such as generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, changes in the arteriolar wall (arteriosclerosis), and abnormalities at points where arterioles and venules cross.
Strongly modulated blood flow pulse in central and branch arteries can result from hypertension.

Diagnosis :

Hypertensive retinopathy is usually asymptomatic and is diagnosed on fundoscopic features. The other conditions which present with optic disc swelling are:

Diabetic papillopathy

Central retinal vein occlusion

Anterior ischemic optic neuropathy

Neuroretinitis

Conditions that mimic chronic hypertensive retinopathy are:

Diabetic retinopathy

Retinal venous obstruction

Hyperviscosity syndrome

Ocular ischemic syndrome

Radiation retinopathy

Treatment / Prevention :

The recommended way to treat hypertensive retinopathy is to adequately control your blood pressure. A major aim of treatment is to prevent, limit, or reverse target organ damage by lowering the person's high blood pressure to reduce the risk of cardiovascular disease and death. Treatment with antihypertensive medications may be required to control high blood pressure. General risk factors are the use of tobacco, alcohol, high salt diet, obesity, and stress.