Hypertensive Retinopathy

What is hypertensive retinopathy?

Hypertensive retinopathy is an eye condition in which high blood pressure damages the layer of tissue at the back of your eyeball (retina). High blood pressure means blood is pushing with more force than normal against your artery walls. Over time, this pressure can damage your arteries and interfere with blood flow to various parts of your body.

With hypertensive retinopathy, high blood pressure disrupts normal blood flow to your retina. Your retina needs enough blood to do its job day in and day out. It’s a crucial job: your retina helps translate light entering your eye into images you can see. You need healthy retinas for good vision. Lack of proper blood flow damages parts of your retina, potentially leading to vision loss and other complications.

But the story doesn’t end there. Hypertensive retinopathy is a condition in its own right, but it’s also a warning sign that you may have blood flow issues elsewhere in your body. That’s because high blood pressure doesn’t just pick and choose which arteries to damage. It typically affects arteries throughout your body. These include arteries that supply blood to major organs like your heart and brain.

The signs of such damage may not show up for years. For some people, hypertensive retinopathy is the first clue that high blood pressure is taking a toll. In fact, people with hypertensive retinopathy have a higher risk of developing cardiovascular (heart and blood vessel) diseases down the road. These include coronary artery disease and stroke.

Learning you have hypertensive retinopathy can be scary. But think of this diagnosis as a flashing yellow light at an intersection. It’s time to slow down and proceed with caution. Talk to your eye care specialist and your healthcare provider. Learn how high blood pressure is affecting your health and how treatment can help you.

How common is this condition?

Hypertensive retinopathy is common among adults over age 40 because its cause (high blood pressure) is common. Researchers estimate hypertensive retinopathy affects anywhere from 4% to 18.7% of adults who don’t have diabetes.

Hypertensive retinopathy affects people of all ethnicities. But it’s more common among Black people and people of Chinese descent.

What are the symptoms of hypertensive retinopathy?

Most people have no symptoms. In severe cases, you may notice you can’t see things as clearly as you used to (low vision).

What causes hypertensive retinopathy?

High blood pressure that persists over a long period of time causes hypertensive retinopathy. Raised pressure in your retina’s blood vessels leads those vessels to tighten for longer than normal (vasospasm). This abnormal tightening narrows the blood vessels’ opening (lumen) and limits how much blood can flow through to your retina. A blood vessel may narrow throughout its length. Or, it may narrow just at one point (like pinching the middle of a straw between two fingers).

Over time, your retina’s blood vessels grow stiff and thick, making it even harder for blood to flow. Continued high blood pressure further damages your blood vessels, leading to complications like vision loss.

What are the risk factors for this condition?

The most important risk factor is long-term high blood pressure. Other risk factors include:

• A history of cardiovascular disease, including carotid artery disease (which affects major arteries in your neck).
• Smoking or tobacco use.
• High cholesterol.
• Obesity.
• High blood sugar (prediabetes or hyperglycemia).
• Elevated levels of a waste product your kidneys normally filter out (creatinine).
• Small amounts of albumin (a type of protein) in your pee.

What are the complications of hypertensive retinopathy?

Without treatment, hypertensive retinopathy can lead to:

• Vision that gradually gets worse, potentially leading to blindness.
• Swelling in your retina (macular edema).
• Lack of blood flow to your retina and optic nerve.
• The pulling away of your retina from the tissues that support it (retinal detachment).

The cause of hypertensive retinopathy (high blood pressure) raises your risk for other eye issues, including:

• A blockage in an artery that supplies blood to your retina (retinal artery occlusion).
• A blockage in a vein that drains blood from your retina (retinal vein occlusion).
• Worsening of diabetes-related retinopathy.

How is hypertensive retinopathy diagnosed?

Eye care specialists diagnose hypertensive retinopathy by:

• Learning about your medical history (including a history of high blood pressure).
• Doing a careful eye exam.
• Taking pictures of your retina (optical coherence tomography and other forms of retinal imaging).

What are the signs of hypertensive retinopathy?

You can’t see the signs of hypertensive retinopathy on your own, but your eye care specialist will look for them in an exam and imaging tests. Signs of this condition in your retina include:

• Narrowing of tiny blood vessels (arterioles).
• Thickening of the arterioles’ walls.
• Small, yellow-white or grayish-white spots that look a bit like clouds (cotton wool spots).
• Tiny red dots (microaneurysms).
• Yellow spots (hard exudates) made of fats and proteins that leak from damaged blood vessels.
• Optic disc swelling (papilledema).

Some signs, like optic disc swelling, may not appear until more advanced stages of the condition.

What are the stages of hypertensive retinopathy?

“Stages” or “grades” are terms healthcare providers use to describe the severity of a specific condition. Providers generally use a four-grade system to identify the severity of hypertensive retinopathy. The grades range from one (general narrowing of the arterioles) to four (signs of severe retinal damage).

Another system classifies your condition into three categories. These are:

• Mild.
• Moderate.
• Malignant (most severe).

Your provider will tell you the stage of your condition — and what that means for you — based on what they can see when examining your eyes.

How do you treat hypertensive retinopathy?

The goal of treatment is to lower your blood pressure, typically with lifestyle changes and/or medications. Your provider will tailor a treatment plan to your needs.

Lifestyle changes include:

• Keeping a weight that’s healthy for you.
• Following a heart-healthy diet, with a particular focus on lowering salt intake.
• Exercising regularly (work up to at least 150 minutes of moderate-intensity activity, like walking, per week).
• Limiting beverages containing alcohol.

If you need blood pressure medications, your provider will tell you more about the types and dosages. It’s important to follow their instructions for how to take your medications and when. Never stop taking your medications without talking to your provider first.

Can you recover from hypertensive retinopathy?

Yes, treatment to lower your blood pressure can help your retinas heal. Research shows that some signs of hypertensive retinopathy go away over time with treatment. But this isn’t always the case, and it depends on the severity of your condition. You have a better chance of reversing retinal damage when you begin treatment in the early stages before the condition gets too severe.

It’s important to work closely with your providers to manage your blood pressure and overall health.

Can I prevent hypertensive retinopathy?

You may be able to prevent this condition by:

• Visiting a healthcare provider each year for a checkup. They’ll measure your blood pressure and tell you the results. Learning you have high blood pressure is the first step toward reducing it.
• Managing high blood pressure. If your numbers are high, your provider will talk to you about ways to get your blood pressure into the healthy range. For example, they may recommend lifestyle changes (like a heart-healthy diet) or regular exercise. They may also prescribe medications.

What can I expect if I have this condition?

Your outlook depends on many factors, including the severity of your condition and how soon you receive treatment. Some people have no vision loss and the signs of hypertensive retinopathy go away after their blood pressure goes down. Others have vision loss or complications that need further treatment.

Your eye care specialist and healthcare provider can tell you more about what to expect in your individual situation.

Hypertensive retinopathy and cardiovascular disease risk

Hypertensive retinopathy can be a warning sign of other blood flow issues throughout your body. These issues may already be happening or may occur down the road. People with hypertensive retinopathy have a higher risk of various cardiovascular diseases. These include problems with your heart and disrupted blood flow in the arteries that supply your brain (carotid arteries).

So, your provider may want to run some tests to check the health of your heart or carotid arteries. Your internal carotid artery’s branches supply blood to your brain as well as your retinas. If your retinas aren’t getting enough blood, there’s a chance your brain might not be, either.

It’s important to work with your provider to lower your risk for these conditions. This may involve making lifestyle changes and taking medications. You may also need treatments to manage existing conditions and lower your risk for serious complications like a stroke.

How do I take care of myself?

One of the most important things you can do is follow your healthcare provider’s guidance for managing your blood pressure. This may mean taking medications regularly. Talk to your provider if you have any questions or concerns about your treatment plan or your ability to follow it.

When should I seek medical care?

Visit a healthcare provider each year for a checkup. They’ll check your vital signs, including your blood pressure. Such regular visits can help you catch problems early before they become more serious.

You should also see an eye care specialist regularly for eye exams. Most adults over age 40 need a complete eye exam every year or two. Your specialist can tell you how often you need to come in based on your eye health, your age and other factors.

When should I go to the emergency room?

Call 911 or your local emergency number if you have symptoms of a hypertensive crisis. This is severely high blood pressure that occurs without warning. Symptoms include:

• A blood pressure reading of 180/120 or higher.
• Chest pain.
• Shortness of breath.
• Numbness.
• Vision changes.
• Trouble talking.

A note from Cleveland Clinic

Learning you have hypertensive retinopathy may come as a shock. Maybe you knew your blood pressure has been high, but you thought it wouldn’t affect your eyes. Or maybe you had no idea your blood pressure wasn’t in the normal range. No matter how you got here, it’s time to learn more about your diagnosis and what it means for you. Work with your eye care specialist and healthcare provider to get the treatment you need. Together, you can protect your vision and your overall health for years to come.