Classification severity grade 1 consists of mild narrowing of the retinal areteriola, while grade 2 has more severe narrowing with areas of the arteriolar narrowing and AV or arteriovenous nicks. Grade 3 has signs of grades 1 and 2 along with hard exudates or cotton spots as well as hemorrhages and microaneurysms. Grade 4 is also called accelerated or malignant hypertensive retinopathy. This grade is seen with all three previous grades’ signs as well as optic disk swelling and macular swelling.
The survival rate for those patients with grade1 hypertensive retinopathy is about 70% at three years, while the survival rate for those with grade 4 is only about 6%. It is hard to determine the early severity from grade 1 to grade 2, and this has prompted doctors to look for new ways to diagnose, and use a 3 grade system of classification.
Classification with 3 grades include stage 1 which is mild, stage 2 which is moderate and stage 3 that covers accelerated or malignant. For patients that have stage 1, regular blood pressure and routine care should be used. People with stage 2 benefit from vascular risk testing for cholesterol and treatment to reduce risks, such as cholesterol lowering medications and exercise.
Those patients with stage 3 hypertensive retinopathy have bilateral disk edema. This is rare but can occur along with severe high blood pressure and will continue to require blood pressure medications and sometimes IV medications. Special attention must be paid in these instances to the blood pressure when first using these medications, to avoid having a sudden major reaction that could lead to stroke.
There have been studies into the regression of the signs of retinopathy with blood pressure being controlled. IT has been seen that patients should be seen regularly for up to 1 year after diagnosis, but many see resolution of the signs within 6 months of controlled blood pressure.