From the Research
The management of hypertensive retinopathy primarily focuses on controlling the underlying hypertension through antihypertensive medications and lifestyle modifications. First-line medications include ACE inhibitors (like lisinopril 10-40 mg daily), angiotensin receptor blockers (such as losartan 25-100 mg daily), calcium channel blockers (amlodipine 5-10 mg daily), or thiazide diuretics (hydrochlorothiazide 12.5-25 mg daily) 1. These should be titrated to achieve a target blood pressure below 130/80 mmHg. Lifestyle modifications are equally important and include reducing sodium intake to less than 2.3g daily, adopting the DASH diet, regular physical activity (150 minutes of moderate exercise weekly), weight management, limiting alcohol consumption, and smoking cessation.
Key Considerations
- Regular follow-up with both ophthalmology and primary care is essential to monitor retinal changes and blood pressure control.
- Severe cases with papilledema (grade 4 retinopathy) require urgent blood pressure reduction to prevent vision loss and other end-organ damage.
- The rationale for aggressive blood pressure management is that hypertensive retinopathy represents microvascular damage from chronic hypertension, and controlling blood pressure can prevent progression of retinal damage and reduce the risk of vision loss, stroke, and other cardiovascular complications 2.
- In cases complicated with retinal neovascularization, treatment with panretinal photocoagulation (PRP) or intravitreal anti-VEGF agents may be considered, as these have been shown to halt the progression of retinal neovascularization 3.
Additional Recommendations
- Younger patients may be at higher risk for grade III/IV hypertensive retinopathy among patients with hypertensive urgency, and thus may require closer monitoring and more aggressive management 4.
- The choice of antihypertensive medication should be individualized based on the patient's specific needs and comorbidities, with consideration given to the potential effects on retinal autoregulation 5.