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Overview of Hypertensive Retinopathy Grades

written by: Victoria Trix • edited by: Leigh A. Zaykoski • updated: 12/20/2009

The four hypertensive retinopathy grades are used to describe the different degrees of damage to the macula or retina, the visual center of the eye.

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    Causes of Hypertensive Retinopathy

    Causes of hypertensive retinopathy include high blood pressure that causes damage to the eye’s blood vessels. When the blood pressure is higher and stays high, the damage gets worse. Using an ophthalmoscope, a doctor can see fluids from the blood vessels in the eye. On the basis of this information hypertensive retinopathy is given a grade from 1 to 4. There are other retinopathies such as diabetic, ischemic, emboli, mirconaeeurysms, vein occlusions and artery occlusions that are known to be complications.

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    Hypertensive Retinopathy Grades Symptoms

    Symptoms of each of the grades include headaches and visual differences including very sudden loss of vision as well as high blood pressure. The prognosis for persons with hypertensive retinopathy grades 4 is not great. Many have kidney and heart problems as well as high blood pressure, but if these are controlled, many will recover. However there are some patients with grade 4 that will always have damage and will incur new damage to the optic nerve or macula due to uncontrolled underlying problems. Vision loss is common in those with stage 4 retinopathy, and no reversal treatment is known at this time.

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    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.

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    Medline Plus from the article Hypertensive Retinopathy last updated September 7, 2008

    Oxford Journals from the article Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality published on September 7, 2005