We searched MEDLINE using PubMed with the search terms “systemic hypertension” and “blood pressure”, in combination with “eye”, “retinopathy”, “retinal arteriolar disease”, “arterio-venous nipping”, “retinal vein occlusion”, “retinal artery occlusion”, “retinal emboli”, “retinal macroaneurysm”, “ischaemic optic neuropathy”, “diabetes”, “glaucoma”, and “age-related macular degeneration”. We largely selected publications in the past 5 years, but did not exclude older publications that are
ReviewThe eye in hypertension
Section snippets
Direct ocular effects of hypertension
Hypertensive retinopathy refers to retinal microvascular signs that are related to raised blood pressure.1 The underlying pathophysiology of these signs can be divided into stages.2 The initial response of the retinal circulation to a rise in blood pressure is vasospasm and an increase in vasomotor tone, which is seen clinically as generalised retinal–arteriolar narrowing. Subsequently, chronic arteriosclerotic changes, such as intimal thickening, media-wall hyperplasia, and hyaline
Retinal vein occlusion
Hypertension predisposes patients to development of retinal vein occlusion, a common, sight-threatening retinal–vascular disorder.42, 43, 44, 45 Retinal vein occlusion is characterised clinically by dilatated and tortuous retinal veins and the presence of retinal haemorrhages, cotton-wool spots, and oedema of the macula and optic disc. These features are seen either in all four quadrants (central retinal vein occlusion; figure 3A), or in only one (branch retinal vein occlusion; figure 3B).
Age-related macular degeneration
Age-related macular degeneration is the most common cause of visual impairment in patients aged 65 years and older in developed countries.93 Visual loss from age-related macular degeneration typically results from either neovascularisation associated with choroidal vessels (commonly termed wet or exudative age-related macular degeneration) or geographic atrophy of the retina.
Some have suggested that hypertension could increase the potential risk factor for age-related macular degeneration, on
Future directions and conclusions
Hypertension affects a large proportion of the adult population worldwide, and has widespread effects on the eye. We argue that any patient with hypertension should have an ophthalmological assessment to detect hypertensive retinopathy or other retinal vascular complications. Individuals with moderate hypertensive retinopathy (eg, flame-shaped or blot-shaped haemorrhages, cotton wool spots, hard exudates, microaneurysms, or a combination of these) are at increased risk of cardiovascular
Search strategy and selection criteria
References (152)
- et al.
Retinal microvascular abnormalities and their relationship with hypertension, cardiovascular disease, and mortality
Surv Ophthalmol
(2001) - et al.
Pathophysiology of hypertensive retinopathy
Ophthalmol
(1982) - et al.
Usefulness of ophthalmoscopy in mild to moderate hypertension
Lancet
(1989) - et al.
Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study
Ophthalmol
(1999) - et al.
Computer-assisted measurement of retinal vessel diameters in the Beaver Dam Eye Study: methodology, correlation between eyes, and effect of refractive errors
Ophthalmol
(2004) - et al.
Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study
Lancet
(2001) - et al.
Retinal microvascular abnormalities and 10-year cardiovascular mortality: a population-based case-control study
Ophthalmol
(2003) - et al.
Systemic diseases associated with various types of retinal vein occlusion
Am J Ophthalmol
(2001) - et al.
Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the Atherosclerosis Risk in Communities and Cardiovascular Health studies
Ophthalmol
(2005) Prevalent misconceptions about acute retinal vascular occlusive disorders
Prog Retin Eye Res
(2005)
Retinal vascular occlusion and deficiencies in the protein C pathway
Am J Ophthalmol
Homocysteine and retinal vein occlusion: a population-based study
Am J Ophthalmol
Retinal vascular obstruction and asymptomatic cerebral infarction
Jpn J Ophthalmol
Intravitreal triamcinolone acetonide for treatment of intraocular proliferative, exudative, and neovascular diseases
Prog Retin Eye Res
Potential sources of emboli in patients with presumed transient cerebral or retinal ischaemia
Lancet
Cardiovascular disease in patients with retinal arterial occlusion
Lancet
Aggressive systematic treatment for central retinal artery occlusion
Am J Ophthalmol
Retinal arterial macroaneurysms
Surv Ophthalmol
Blood flow in the optic nerve head and factors that may influence it
Prog Retin Eye Res
Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy
Am J Ophthalmol
Incidence of nonarteritic anterior ischemic optic neuropathy
Am J Ophthalmol
The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema
Ophthalmol
Are retinal arteriolar abnormalities related to atherosclerosis?: The Atherosclerosis Risk in Communities Study
Arterioscler Thromb Vasc Biol
Impaired endothelial function of the retinal vasculature in hypertensive patients
Stroke
Plasma vascular endothelial growth factor as a marker for early vascular damage in hypertension
Clinl Sci
Some different types of essential hypertension: their course and prognosis
Am J Med Sci
Hypertensive retinopathy
N Engl J Med
Hypertension and retinopathy, arteriolar narrowing, and arteriovenous nicking in a population
Arch Ophthalmol
Retinopathy in older persons without diabetes and its relationship to hypertension
Arch Ophthalmol
Retinal vessel diameters and their associations with age and blood pressure
Invest Ophthalmol Vis Sci
Hypertensive retinal vessel wall signs in a general older population: the Blue Mountains Eye Study
Hypertension
The relation of systemic hypertension to changes in the retinal vasculature: the Beaver Dam Eye Study
Trans Am Ophthalmol Soc
Retinal arteriolar diameters and elevated blood pressure: the Atherosclerosis Risk in Communities Study
Am J Epidemiol
Retinal microvascular abnormalities and blood pressure in older people: the Cardiovascular Health Study
Br J Ophthalmol
Impact of current and past blood pressure on retinal arteriolar diameter in an older population
J Hypertens
Retinal arteriolar diameter and risk for hypertension
Ann Intern Med
Prospective cohort study of retinal vessel diameters and risk of hypertension
BMJ
Retinal arteriolar narrowing is associated with 5-year incident severe hypertension: the Blue Mountains Eye Study
Hypertens
Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures
J Anat
Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis Risk in Communities Study
Stroke
Cerebral white matter lesions, retinopathy, and incident clinical stroke
JAMA
Retinal arterial changes correlate with cerebral small-vessel disease
Neurology
Retinal microvascular changes and MRI signs of cerebral atrophy in healthy, middle-aged people
Neurology
Retinal microvascular signs and risk of stroke and stroke mortality
Neurology
Value of routine funduscopy in patients with hypertension: systematic review
BMJ
Retinal arteriolar changes as an indicator of coronary artery disease
Arch Intern Med
Hypertensive retinopathy and incident coronary heart disease in high risk men
Br J Ophthalmol
Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study
JAMA
Retinopathy and risk of congestive heart failure
JAMA
Retinal microvascular abnormalities and renal dysfunction: the atherosclerosis risk in communities study
J Am Soc Neph
Cited by (483)
Hypertension-associated changes in retinal blood vessel walls measured in vivo with polarization-sensitive optical coherence tomography
2024, Optics and Lasers in EngineeringAssociations of concomitant retinopathy and depression with mortality in a nationally representative population
2023, Journal of Affective DisordersIncreased Risks of Open-Angle Glaucoma in Untreated Hypertension
2023, American Journal of OphthalmologySystematic review and meta-analysis of retinal microvascular caliber in bipolar disorder, major depressive disorder, and schizophrenia
2023, Journal of Affective Disorders