Hypertensive retinopathy is damage to your retinas resulting from long-term high blood pressure disrupting blood flow to that area. The condition is asymptomatic until the advanced stages, when you are more likely to experience vision loss and other health complications. Learn more about how hypertensive retinopathy is diagnosed, how it’s treated, and who is most at risk.*

What is hypertensive retinopathy?

Hypertensive retinopathy occurs when high blood pressure damages the retinal tissue layer at the back of your eye. High blood pressure means blood is pushing with more force than normal against your artery walls. Over time, this pressure can thicken and stiffen your arteries and interfere with blood flow to various parts of your body, including your eyes. The condition is usually categorized as mild, moderate, or severe. Severe hypertensive retinopathy is referred to as “malignant” but is not related to cancer.

Who is at risk for hypertensive retinopathy?

The people most at risk for developing hypertensive retinopathy are those with long-term high blood pressure. Other risk factors include:

• Age 40 or older
• African or Chinese descent (though all races and ethnicities can be affected)

• History of cardiovascular disease
• Obesity
• Smoking or tobacco use
• High cholesterol or high blood sugar
• High levels of proteins in the blood or urine that the kidneys usually filter out 

What complications can hypertensive retinopathy lead to?

Without appropriate treatment, hypertensive retinopathy can lead to:

• Macular edema (swelling of the retina)
• Insufficient blood flow to the retina and optic nerve (that can lead to glaucoma)
• Retinal detachment
• Worsening of diabetes-related retinopathy
• Blockages in a retinal vein or artery
• Blindness

Hypertensive retinopathy can also be a warning sign that you have other blood flow issues in your body, including in arteries that supply blood to your heart, brain, and other major organs.

How is hypertensive retinopathy diagnosed?

When diagnosing hypertensive retinopathy, your eye doctor will:

• Ask about your medical history (especially about your blood pressure)
• Do a comprehensive eye exam
• Take images of your retina 

While you won’t be able to observe the signs of hypertensive retinopathy on your own, your eye doctor will look for:

• Narrowing and thickening of tiny blood vessels called arterioles
• Small, cloudy yellow-white or grayish-white spots 
• Microaneurysms that appear as tiny red dots 
• Bits of fats and proteins from damaged blood vessels, appearing as yellow spots 
• Swelling of the optic disc (may not appear until advanced stages)

How is hypertensive retinopathy treated?

The primary goal of treatment for hypertensive retinopathy is to lower your overall blood pressure. This is generally accomplished with a combination of medications and lifestyle tweaks. Classes of blood pressure-lowering medications include:

• ACE inhibitors
• Alpha-2 receptor agonists
• Alpha and beta blockers
• Angiotensin II receptor blockers
• Calcium channel blockers
• Diuretics
• Vasodilators 

Lifestyle habits include:

• Achieving and maintaining a healthy weight 
• Following a heart-healthy diet that is high in fresh fruits and vegetables and low in sodium and trans fats
• Exercising regularly and appropriately for your age and ability 
• Limiting your alcohol intake

What’s the general prognosis for hypertensive retinopathy?

If you have hypertensive retinopathy, your prognosis will largely depend on the severity of the condition and your adherence to your treatment regimen. As with most health conditions, early detection and treatment supports the best outcomes.

Prevention is the best defense, and you can be proactive by:

• Getting regular doctor checkups and comprehensive eye exams,
• Learning about high blood pressure, its causes, its impacts, and ways to control it, and
• Effectively managing your blood pressure by working closely with your doctor. 

*Cleveland Clinic. (2023, June 18). Hypertensive Retinopathy. https://my.clevelandclinic.org/health/diseases/25100-hypertensive-retinopathy

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