Pathophysiology
The changes in hypertensive retinopathy result from damage and adaptive changes in the arterial and arteriolar circulation in response to the high blood pressure. Diagnosis
Fundoscopy and patients history. Differential Diagnoses
Several other diseases can result in retinopathy that can be confused with hypertensive retinopathy. These include diabetic retinopathy, retinopathy due to autoimmune disease, anemia, radiation retinopathy, and central retinal vein occlusion. Keith Wagener Barker (KWB) Grades
Grade 1
Vascular Attenuation
Grade 2
As grade 1 + Irregularly located, tight constrictions – Known as "AV nicking" or "AV nipping" – Saluss sign
Grade 3
As grade 2 + Retinal edema, cotton wool spots and flame-hemorrhages "Copper Wiring" + Bonnets Sign + Gunns Sign
Grade 4
As grade 3 + optic disc edema + macular star "Silver Wiring"There is an association between the grade of retinopathy and mortality. In a classic study in 1939 Keith and colleagues described the prognosis of people with differing severity of retinopathy. They showed 70% of those with grade 1 retinopathy were alive after 3 years whereas only 6% of those with grade 4 survived. The most widely used modern classification system bears their name. The role of retinopathy grading in risk stratification is debated, but it has been proposed that  individuals with signs of hypertensive retinopathy signs, especially retinal hemorrhages, microaneurysms and cotton-wool spots, should be assessed carefully. Management
A major aim of treatment is to prevent, limit, or reverse target organ damage by lowering the persons high blood pressure to reduce the risk of cardiovascular disease and death.
Treatment with antihypertensive medications may be required to control the high blood pressure. See also
Hypertensive crisis
List of systemic diseases with ocular manifestations
Ophthalmology
Optometry

References
Further reading
The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, J.B. Lippincott, 1994. Hypertensive retinopathy


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