Regression of retinal vascular changes by antihypertensive therapy

The features of hypertensive retinal arterial vessel changes and their sequelae are reviewed. General or focal narrowing, increased reflexes or abnormal arteriovenous crossings, are often associated with, but not specific for, hypertension. They persist, with very rare exceptions, even after long-term successful antihypertensive therapy. Papilledema, cotton-wool spots, hemorrhages, and fatty exudates in malignant hypertension disappear completely within 6 to 12 months if blood pressure is well controlled. Inadequate control of elevated blood pressure delays, but does not prevent, the regression of retinopathy. The reversal into the "benign" phase may continue for years, even if blood pressure control worsens. This may be explained by a regain of autoregulation which allows the arteriolonecrotic lesions to heal. According to their size, retinal arteries are representative of the target organ of hypertensive small vessel disease. They supply a tissue that is highly sensitive to ischemia. However, even long-standing nonmalignant hypertension seems not to damage retinal tissue.