1. Disease Information

1.1 Concise overview (current understanding)

Hypertensive retinopathy (HR) is commonly defined as retinal microvascular signs that develop in response to raised blood pressure, representing ocular end-organ involvement of hypertension. A widely used clinical framework is the Keith–Wagener–Barker (KWB) grading system, where severe grades reflect accelerated/malignant hypertensive states and worse prognosis. (marco2022aliteraturereview pages 2-4, kulkarni2023managementofhypertensive pages 2-3)

A key pathogenetic clarification—particularly relevant in malignant hypertension—is that fundus lesions can be separated into (1) hypertensive retinopathy, (2) hypertensive choroidopathy, and (3) hypertensive optic neuropathy; notably, optic disc edema, historically included within hypertensive retinopathy, is better considered hypertensive optic neuropathy. (kim2023hypertensiveretinopathy pages 1-2)

1.2 Key identifiers (ontology/terminology)

• ICD-10/ICD-11, MeSH, MONDO, OMIM, Orphanet: These identifiers were not present in the retrieved full-text evidence in this run; therefore they cannot be asserted here with primary citations.
• Clinical grading systems used in current practice/literature: Keith–Wagener–Barker (KWB) grades 1–4; other grading systems (Scheie; Wong–Mitchell) are referenced in synthesis literature. (marco2022aliteraturereview pages 4-6)

1.3 Synonyms and alternative names

Historical terminology includes “albuminuric retinitis,” “angiospastic retinopathy,” and “hypertensive neuroretinopathy,” reflecting early descriptions linking severe hypertension and renal disease. (kim2023hypertensiveretinopathy pages 1-2)

1.4 Evidence source type

Evidence is primarily from aggregated disease-level resources (cohorts, systematic reviews, imaging studies, clinical guidance). The retinopathy/choroidopathy/optic-neuropathy separation is grounded in pathogenetic clinical research and clinicopathologic interpretation. (kim2023hypertensiveretinopathy pages 1-2, marco2022aliteraturereview pages 2-4)

2. Etiology

2.1 Causal factors

Primary causal driver: systemic arterial hypertension (sustained or acutely severe) producing retinal microvascular autoregulatory stress, endothelial injury, and (in severe states) blood–retina barrier disruption. (marco2022aliteraturereview pages 2-4, kim2023hypertensiveretinopathy pages 2-3)

Secondary/mediating mechanisms emphasized in recent mechanistic/imaging work: * Autoregulation failure when BP rises beyond autoregulatory thresholds, associated with endothelial injury and vascular permeability changes. (kim2023hypertensiveretinopathy pages 2-3) * Renin–angiotensin–aldosterone system (RAAS) activation and excess angiotensin II (particularly in renal/secondary hypertension) driving vasoconstriction/vasospasm, arterial stiffness, reduced retinal perfusion, and reduced OCTA-measured vascular density. (wang2024octaevaluateschanges pages 6-7, wang2024octaevaluateschanges pages 9-10)

2.2 Risk factors (representative)

• Degree and duration of hypertension (epidemiology difficult to quantify precisely due to confounding retinal vascular diseases, but incidence rises with severity and duration). (marco2022aliteraturereview pages 1-2)
• Chronic kidney disease / renal hypertension as a systemic context with high burden of hypertensive retinal microvascular abnormalities and reduced OCTA vessel density. (wang2024octaevaluateschanges pages 9-10)
• Ethnicity/sex effect modification: BIHS position paper notes that while hypertension/retinopathy are overall more prevalent in Afro-Caribbeans than Europeans, the relationship between hypertension and retinopathy prevalence is stronger in Europeans (particularly women) and weaker in Afro-Caribbeans (especially women). (kulkarni2023managementofhypertensive pages 2-3)

2.3 Protective factors

No evidence for specific genetic or environmental protective factors was identified in the retrieved set.

2.4 Gene–environment interactions

No hypertensive-retinopathy-specific gene–environment interaction evidence was identified.

3. Phenotypes

3.1 Classic fundus signs

A synthesis review describes classic HR signs: generalized or focal arteriolar narrowing, arteriovenous (AV) nicking, copper/silver wiring, flame-shaped and dot-blot hemorrhages, hard exudates, cotton-wool spots, and microaneurysms; malignant disease may include papilledema, congested veins, and macular star. (marco2022aliteraturereview pages 2-4, marco2022aliteraturereview pages 4-6)

KWB grading (explicit features from 2023 BIHS): * Grade 1: mild narrowing/sclerosis of retinal arterioles * Grade 2: moderate–severe arteriolar changes + venous compression at AV crossings + exaggerated arterial light reflex * Grade 3: flame/dot hemorrhages, cotton-wool spots, hard exudates, microaneurysms * Grade 4: bilateral papilloedema (optic disc swelling) (kulkarni2023managementofhypertensive pages 2-3)

3.2 Retinal layers/structural phenotypes (OCT/OCTA era)

Cotton-wool spots correspond to ischemic lesions with RNFL involvement, and structural sequelae may persist with RNFL thinning and inner retinal layer changes (e.g., ganglion cell-inner plexiform layer complex). (marco2022aliteraturereview pages 6-7)

3.3 Distinguishing related entities (malignant hypertension)

Fundus lesions in malignant hypertension can be separated into hypertensive retinopathy vs choroidopathy vs optic neuropathy; optic disc edema maps to optic neuropathy rather than retinopathy. (kim2023hypertensiveretinopathy pages 1-2, marco2022aliteraturereview pages 4-6)

Suggested HPO term mappings (ontology suggestions; not evidence-asserted)

• Retinal hemorrhage; cotton-wool spots (retinal nerve fiber layer infarcts); hard exudates; papilledema; macular edema; abnormal retinal vasculature/arteriolar narrowing/AV nicking.

4. Genetic/Molecular Information

4.1 Causal genes and pathogenic variants

HR is best characterized as a complex phenotype/end-organ manifestation of systemic hypertension rather than a monogenic disorder; no HR-specific causal genes or pathogenic variants were identified in the retrieved evidence.

4.2 Molecular mediators and pathways

Key mediators include endothelial dysfunction and barrier breakdown in severe states (kim2023hypertensiveretinopathy pages 2-3), and RAAS/angiotensin II-associated vasoconstriction/vasospasm with downstream vascular dysfunction in renal hypertension (wang2024octaevaluateschanges pages 6-7, wang2024octaevaluateschanges pages 9-10). A synthesis review also highlights angiotensin II–VEGF connections in HR pathophysiology. (marco2022aliteraturereview pages 2-4)

No omics (transcriptomic/proteomic/metabolomic/epigenomic) profiling evidence was identified.

5. Environmental Information

HR is driven primarily by systemic BP exposure and systemic vascular risk context. No toxin/pathogen causal triggers were identified in this run.

6. Mechanism / Pathophysiology (causal chain)

A useful mechanistic framework (synthesis review) divides HR into phases:

1. Vasoconstrictive phase (acute BP elevation): autoregulatory vasoconstriction/vasospasm → generalized/focal retinal arteriolar narrowing. (marco2022aliteraturereview pages 2-4)
2. Sclerotic phase (chronic hypertension): endothelial injury, intimal thickening, medial hyperplasia, hyaline degeneration → AV nicking and copper/silver wiring. (marco2022aliteraturereview pages 2-4)
3. Exudative phase (severe/accelerated hypertension): blood–retina barrier disruption and permeability → hemorrhages, hard exudates, cotton-wool spots, microaneurysms. (marco2022aliteraturereview pages 2-4)

In renal hypertension, RAAS activation and angiotensin II excess are emphasized as drivers of vasoconstriction/vasospasm and reduced retinal perfusion/vascular density on OCTA. (wang2024octaevaluateschanges pages 6-7, wang2024octaevaluateschanges pages 9-10)

Suggested GO/CL terms (ontology suggestions): endothelial cell dysfunction; regulation of blood vessel diameter; regulation of vascular permeability; oxidative stress response; retinal ganglion cell injury; pericyte/endothelial involvement.

7. Anatomical Structures Affected

• Retina and retinal microvasculature (arterioles/capillaries/venules) with inner retinal layer effects (RNFL, ganglion cell complex). (marco2022aliteraturereview pages 2-4, marco2022aliteraturereview pages 6-7)
• Choroid/RPE in hypertensive choroidopathy (choroidal ischemia/RPE lesions). (marco2022aliteraturereview pages 4-6, kim2023hypertensiveretinopathy pages 2-3)
• Optic nerve head in hypertensive optic neuropathy (disc hemorrhage/papilledema). (marco2022aliteraturereview pages 4-6, kim2023hypertensiveretinopathy pages 1-2)

8. Temporal Development

• Chronic course with remodeling signs (arteriolar narrowing, AV nicking, wiring) vs acute/severe presentations with exudative lesions and disc edema. (marco2022aliteraturereview pages 2-4, kulkarni2023managementofhypertensive pages 2-3)
• Staging via KWB grades 1–4. (kulkarni2023managementofhypertensive pages 2-3)
• OCTA-based 3-stage capillary sparsity/nonperfusion patterns proposed as staging surrogates in synthesis literature. (marco2022aliteraturereview pages 6-7)

9. Inheritance and Population

HR is complex/multifactorial; inheritance is not Mendelian in this evidence set.

Epidemiology (recent quantitative evidence prioritized)

• 6–15% prevalence in non-diabetic adults ≥40 years (noted as potentially underestimated). (wang2024octaevaluateschanges pages 6-7)
• In a CKD+hypertension cohort context, HR reported in >70% of non-diabetic hypertensive patients with CKD, with CKD severity linked to progression. (wang2024octaevaluateschanges pages 9-10)

Malignant hypertension prevalence (related severe phenotype)

BIHS position document reports malignant hypertension prevalence approximately 1–2/100,000 in Caucasian populations and 7.3/100,000 in African American populations. (kulkarni2023managementofhypertensive pages 2-3)

10. Diagnostics

10.1 Ophthalmoscopy / fundus photography

Traditional grading systems (e.g., KWB; Wong–Mitchell) are limited by subjectivity and interobserver variability. (marco2022aliteraturereview pages 1-2, pinto2022arterialhypertensionand pages 2-3)

10.2 Quantitative retinal vascular metrics (photo-based)

Computer-based analysis improves reproducibility and enables follow-up using standardized measures such as CRAE, CRVE, and AVR from digital photographs. (pinto2022arterialhypertensionand pages 2-3)

10.3 OCT and OCTA

Synthesis literature highlights OCT as a reproducible technique for vessel measurements and OCTA as a rapid, noninvasive method for detecting microvascular changes (vessel density/perfusion density/FAZ changes) even without overt clinical HR. (marco2022aliteraturereview pages 4-6, marco2022aliteraturereview pages 6-7)

A 2024 renal-hypertension OCTA study illustrates practical OCTA implementation: SVP/DVP density differences across segmentation approaches and potential for early detection and progression monitoring. (wang2024octaevaluateschanges pages 1-2, wang2024octaevaluateschanges pages 9-10)

10.4 Standardization and QC (key implementation issue)

• OSCAR-MP (2023) provides consensus QC criteria for OCTA artifacts/quality and achieved high interrater agreement for rejecting poor-quality scans. (wicklein2023theoscarmpconsensus pages 1-2)
• A 2024 systematic review/meta-analysis emphasizes massive heterogeneity of OCTA analysis approaches and calls for standardized reporting and minimum datasets (e.g., parafoveal vessel density and FAZ area). (courtie2024opticalcoherencetomography pages 34-35)

11. Outcome / Prognosis

Stroke/CVD associations (recent systematic review)

A 2024 systematic review of retinal imaging biomarkers for stroke risk reports that retinopathy presence is strongly associated with increased stroke risk; meta-analysis reports HR 2.70 (p<0.0001) for “retinopathy of any type.” (girach2024retinalimagingfor pages 7-8, girach2024retinalimagingfor pages 1-2)

BIHS notes severe retinal changes (KWB grades 3–4) reflect severe vascular permeability and poor prognosis in malignant hypertension contexts. (kulkarni2023managementofhypertensive pages 2-3)

12. Treatment

12.1 Core management

Primary therapy is systemic blood pressure reduction and vascular risk management, coordinated with primary care/internal medicine; fundus findings can guide intensity/urgency. (marco2022aliteraturereview pages 11-14)

The 2022 synthesis review states that grade III/IV retinopathy should be managed urgently and that fundus exam should be performed in suspected hypertensive emergencies to guide treatment intensity. (marco2022aliteraturereview pages 11-14)

12.2 Hypertensive crisis / malignant hypertension guidance (2023 BIHS)

BIHS emphasizes careful BP lowering to avoid hypoperfusion and ischemic complications; for uncomplicated malignant hypertension with eye changes alone, targets include: <200/120 mmHg within 24 h, <160/100 mmHg within 1 week, and <140/90 mmHg within 6–12 weeks. (kulkarni2023managementofhypertensive pages 7-8)

General emergency principle: reduce MAP no more than ~20–25% in first 6–24 hours. (kulkarni2023managementofhypertensive pages 7-8, kulkarni2023managementofhypertensive pages 5-7)

12.3 Ocular-directed adjuncts

The 2022 synthesis review notes intravitreal anti-VEGF antibodies have been reported to reduce macular edema/hemorrhages, but are not widely established as standard HR therapy. (marco2022aliteraturereview pages 11-14)

Suggested MAXO terms (ontology suggestions): antihypertensive therapy; emergency BP management; intensive monitoring/admission; fundus photography; OCT; OCTA; intravitreal anti-VEGF therapy (selected cases).

13. Prevention

• Primary prevention: prevent HR by controlling hypertension and improving medication adherence/escalation. (kulkarni2023managementofhypertensive pages 3-3)
• Secondary prevention: retinal imaging as a window for hypertension-mediated organ damage assessment; quantitative methods may support earlier detection than subjective grading. (pinto2022arterialhypertensionand pages 1-2, pinto2022arterialhypertensionand pages 2-3)

14. Other Species / Natural Disease

No comparative/veterinary HR evidence was identified in the retrieved set.

15. Model Organisms

No model organism resources specific to HR were identified in the retrieved set.

Recent Developments and Real-World Implementations (2023–2024 emphasis)

AI/ML applications

A 2024 IEEE Access review describes expanding use of CNN-based ML/DL methods for automated analysis of diabetic and hypertensive retinopathy, emphasizing improved accessibility and screening potential (with particular relevance to resource-limited settings). (urinatriana2024machinelearningand pages 16-17)

Clinical trial implementations (real-world grading/measurement)

• RetinAIcheck (CNN) for HR grading (ClinicalTrials.gov NCT07471971; observational): trained on 30,000 specialist-relabeled fundus photographs; tested in 729 patients (1,401 eyes); grades HR by KWB classification; online resource: https://retinaai.sechenov.ru/. (NCT07471971 chunk 1)
• Retinal blood flow measurement in HR (ClinicalTrials.gov NCT01753648): stage 2–3 HR vs matched controls; endpoints include total retinal blood flow, vessel diameter, velocities, and oxygen saturation using Dynamic Vessel Analyzer and Fourier-domain OCT methods. (NCT01753648 chunk 1)

Summary table (grading, mechanisms, key statistics)

Table: This table condenses the most useful disease-characteristic facts for hypertensive retinopathy: classic grading/signs, mechanism-to-phenotype mapping, and recent quantitative prognostic and epidemiologic data. It is useful as a quick reference for building a structured knowledge-base entry.

Direct abstract-supported statements (quotes)

• “Retinal imaging allows non-invasive assessment of the microvasculature.” (2024 stroke-risk systematic review) (girach2024retinalimagingfor pages 7-8)
• “To date, there are no validated consensus criteria for quality control (QC) of OCTA.” (2023 OSCAR-MP paper) (wicklein2023theoscarmpconsensus pages 1-2)
• “Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice.” (2023 BIHS position paper) (kulkarni2023managementofhypertensive pages 2-3)

Gaps / limitations of this run

1. ICD/MeSH/MONDO/OMIM/Orphanet IDs were not available in the retrieved evidence texts; identifiers are therefore not asserted.
2. Image retrieval: attempts to retrieve and cite a cropped figure/table failed due to tool access errors; thus, no image citations are included.
3. Genetic/omics: no HR-specific GWAS/omics/epigenetic profiling evidence was identified in the retrieved set.

Key URLs and publication dates (subset of cited sources)

• Kulkarni et al. Journal of Human Hypertension (Nov 2023): https://doi.org/10.1038/s41371-022-00776-9 (kulkarni2023managementofhypertensive pages 2-3)
• Wang et al. Scientific Reports (Nov 2024): https://doi.org/10.1038/s41598-024-68690-3 (wang2024octaevaluateschanges pages 9-10)
• Girach et al. Journal of Neurology (Mar 2024): https://doi.org/10.1007/s00415-023-12171-6 (girach2024retinalimagingfor pages 7-8)
• Wicklein et al. Neurol Neuroimmunol Neuroinflamm (Nov 2023): https://doi.org/10.1212/nxi.0000000000200169 (wicklein2023theoscarmpconsensus pages 1-2)
• Courtie et al. Scientific Reports (Apr 2024): https://doi.org/10.1038/s41598-024-54306-3 (courtie2024opticalcoherencetomography pages 34-35)
• Del Pinto et al. Nutrients (May 2022): https://doi.org/10.3390/nu14112200 (pinto2022arterialhypertensionand pages 1-2)
• Di Marco et al. Eur Rev Med Pharmacol Sci (Sep 2022): https://doi.org/10.26355/eurrev_202209_29742 (marco2022aliteraturereview pages 2-4)
• ClinicalTrials.gov NCT07471971 (resource): https://retinaai.sechenov.ru/ (NCT07471971 chunk 1)

References

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2. (kulkarni2023managementofhypertensive pages 2-3): Spoorthy Kulkarni, Mark Glover, Vikas Kapil, S. M. L. Abrams, Sarah Partridge, Terry McCormack, Peter Sever, Christian Delles, and Ian B. Wilkinson. Management of hypertensive crisis: british and irish hypertension society position document. Journal of Human Hypertension, 37:863-879, Nov 2023. URL: https://doi.org/10.1038/s41371-022-00776-9, doi:10.1038/s41371-022-00776-9. This article has 119 citations and is from a peer-reviewed journal.

3. (kim2023hypertensiveretinopathy pages 1-2): Ophthalmologica and Sohan Singh. Hypertensive retinopathy. Definitions, Jan 2020. URL: https://doi.org/10.1159/000309997, doi:10.1159/000309997. This article has 383 citations.

4. (marco2022aliteraturereview pages 4-6): E. Di Marco, F. Aiello, M. Lombardo, M. Di Marino, F. Missiroli, R. Mancino, F. Ricci, C. Nucci, A. Noce, N. Di Daniele, and M. Cesareo. A literature review of hypertensive retinopathy: systemic correlations and new technologies. European review for medical and pharmacological sciences, 26 18:6424-6443, Sep 2022. URL: https://doi.org/10.26355/eurrev_202209_29742, doi:10.26355/eurrev_202209_29742. This article has 67 citations.

5. (kim2023hypertensiveretinopathy pages 2-3): Ophthalmologica and Sohan Singh. Hypertensive retinopathy. Definitions, Jan 2020. URL: https://doi.org/10.1159/000309997, doi:10.1159/000309997. This article has 383 citations.

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7. (wang2024octaevaluateschanges pages 9-10): Le Wang, Jun-Yi Wang, Cheng Chen, Min Kang, San-Hua Xu, Hong Wei, Qian Ling, Liang-Qi He, Jie Zou, Xu Chen, Ping Ying, Hui Huang, and Yi Shao. Octa evaluates changes in retinal microvasculature in renal hypertension patients. Scientific Reports, Nov 2024. URL: https://doi.org/10.1038/s41598-024-68690-3, doi:10.1038/s41598-024-68690-3. This article has 11 citations and is from a peer-reviewed journal.

8. (marco2022aliteraturereview pages 1-2): E. Di Marco, F. Aiello, M. Lombardo, M. Di Marino, F. Missiroli, R. Mancino, F. Ricci, C. Nucci, A. Noce, N. Di Daniele, and M. Cesareo. A literature review of hypertensive retinopathy: systemic correlations and new technologies. European review for medical and pharmacological sciences, 26 18:6424-6443, Sep 2022. URL: https://doi.org/10.26355/eurrev_202209_29742, doi:10.26355/eurrev_202209_29742. This article has 67 citations.

9. (marco2022aliteraturereview pages 6-7): E. Di Marco, F. Aiello, M. Lombardo, M. Di Marino, F. Missiroli, R. Mancino, F. Ricci, C. Nucci, A. Noce, N. Di Daniele, and M. Cesareo. A literature review of hypertensive retinopathy: systemic correlations and new technologies. European review for medical and pharmacological sciences, 26 18:6424-6443, Sep 2022. URL: https://doi.org/10.26355/eurrev_202209_29742, doi:10.26355/eurrev_202209_29742. This article has 67 citations.

10. (pinto2022arterialhypertensionand pages 2-3): Rita Del Pinto, Giuseppe Mulè, Maria Vadalà, Caterina Carollo, Santina Cottone, Claudia Agabiti Rosei, Carolina De Ciuceis, Damiano Rizzoni, Claudio Ferri, and Maria Lorenza Muiesan. Arterial hypertension and the hidden disease of the eye: diagnostic tools and therapeutic strategies. Nutrients, 14:2200, May 2022. URL: https://doi.org/10.3390/nu14112200, doi:10.3390/nu14112200. This article has 31 citations.

11. (wang2024octaevaluateschanges pages 1-2): Le Wang, Jun-Yi Wang, Cheng Chen, Min Kang, San-Hua Xu, Hong Wei, Qian Ling, Liang-Qi He, Jie Zou, Xu Chen, Ping Ying, Hui Huang, and Yi Shao. Octa evaluates changes in retinal microvasculature in renal hypertension patients. Scientific Reports, Nov 2024. URL: https://doi.org/10.1038/s41598-024-68690-3, doi:10.1038/s41598-024-68690-3. This article has 11 citations and is from a peer-reviewed journal.

12. (wicklein2023theoscarmpconsensus pages 1-2): Rebecca Wicklein, Charmaine Yam, Christina Noll, Lilian Aly, Nicolas Banze, Eva Feodora Romahn, Elisabeth Wolf, Bernhard Hemmer, Frederike C. Oertel, Hanna Zimmermann, Philipp Albrecht, Marius Ringelstein, Carmen Baumann, Nikolaus Feucht, Josef Penkava, Joachim Havla, Jonathan A. Gernert, Christian Mardin, Eleni S. Vasileiou, Anneke Van Der Walt, Omar Al-Louzi, Sergio Cabello, Angela Vidal-Jordana, Julia Krämer, Heinz Wiendl, Jana Lizrova Preiningerova, Olga Ciccarelli, Elena Garcia-Martin, Veronika Kana, Peter A. Calabresi, Friedemann Paul, Shiv Saidha, Axel Petzold, Ahmed T. Toosy, and Benjamin Knier. The oscar-mp consensus criteria for quality assessment of retinal optical coherence tomography angiography. Neurology Neuroimmunology & Neuroinflammation, Nov 2023. URL: https://doi.org/10.1212/nxi.0000000000200169, doi:10.1212/nxi.0000000000200169. This article has 35 citations.

13. (courtie2024opticalcoherencetomography pages 34-35): Ella Courtie, James Robert Moore Kirkpatrick, Matthew Taylor, Livia Faes, Xiaoxuan Liu, Ann Logan, Tonny Veenith, Alastair K. Denniston, and Richard J. Blanch. Optical coherence tomography angiography analysis methods: a systematic review and meta-analysis. Scientific Reports, Apr 2024. URL: https://doi.org/10.1038/s41598-024-54306-3, doi:10.1038/s41598-024-54306-3. This article has 18 citations and is from a peer-reviewed journal.

14. (girach2024retinalimagingfor pages 7-8): Zain Girach, Arni Sarian, Cynthia Maldonado-García, Nishant Ravikumar, Panagiotis I. Sergouniotis, Peter M. Rothwell, Alejandro F. Frangi, and Thomas H. Julian. Retinal imaging for the assessment of stroke risk: a systematic review. Journal of neurology, 271:2285-2297, Mar 2024. URL: https://doi.org/10.1007/s00415-023-12171-6, doi:10.1007/s00415-023-12171-6. This article has 40 citations and is from a domain leading peer-reviewed journal.

15. (girach2024retinalimagingfor pages 1-2): Zain Girach, Arni Sarian, Cynthia Maldonado-García, Nishant Ravikumar, Panagiotis I. Sergouniotis, Peter M. Rothwell, Alejandro F. Frangi, and Thomas H. Julian. Retinal imaging for the assessment of stroke risk: a systematic review. Journal of neurology, 271:2285-2297, Mar 2024. URL: https://doi.org/10.1007/s00415-023-12171-6, doi:10.1007/s00415-023-12171-6. This article has 40 citations and is from a domain leading peer-reviewed journal.

16. (marco2022aliteraturereview pages 11-14): E. Di Marco, F. Aiello, M. Lombardo, M. Di Marino, F. Missiroli, R. Mancino, F. Ricci, C. Nucci, A. Noce, N. Di Daniele, and M. Cesareo. A literature review of hypertensive retinopathy: systemic correlations and new technologies. European review for medical and pharmacological sciences, 26 18:6424-6443, Sep 2022. URL: https://doi.org/10.26355/eurrev_202209_29742, doi:10.26355/eurrev_202209_29742. This article has 67 citations.

17. (kulkarni2023managementofhypertensive pages 7-8): Spoorthy Kulkarni, Mark Glover, Vikas Kapil, S. M. L. Abrams, Sarah Partridge, Terry McCormack, Peter Sever, Christian Delles, and Ian B. Wilkinson. Management of hypertensive crisis: british and irish hypertension society position document. Journal of Human Hypertension, 37:863-879, Nov 2023. URL: https://doi.org/10.1038/s41371-022-00776-9, doi:10.1038/s41371-022-00776-9. This article has 119 citations and is from a peer-reviewed journal.

18. (kulkarni2023managementofhypertensive pages 5-7): Spoorthy Kulkarni, Mark Glover, Vikas Kapil, S. M. L. Abrams, Sarah Partridge, Terry McCormack, Peter Sever, Christian Delles, and Ian B. Wilkinson. Management of hypertensive crisis: british and irish hypertension society position document. Journal of Human Hypertension, 37:863-879, Nov 2023. URL: https://doi.org/10.1038/s41371-022-00776-9, doi:10.1038/s41371-022-00776-9. This article has 119 citations and is from a peer-reviewed journal.

19. (kulkarni2023managementofhypertensive pages 3-3): Spoorthy Kulkarni, Mark Glover, Vikas Kapil, S. M. L. Abrams, Sarah Partridge, Terry McCormack, Peter Sever, Christian Delles, and Ian B. Wilkinson. Management of hypertensive crisis: british and irish hypertension society position document. Journal of Human Hypertension, 37:863-879, Nov 2023. URL: https://doi.org/10.1038/s41371-022-00776-9, doi:10.1038/s41371-022-00776-9. This article has 119 citations and is from a peer-reviewed journal.

20. (pinto2022arterialhypertensionand pages 1-2): Rita Del Pinto, Giuseppe Mulè, Maria Vadalà, Caterina Carollo, Santina Cottone, Claudia Agabiti Rosei, Carolina De Ciuceis, Damiano Rizzoni, Claudio Ferri, and Maria Lorenza Muiesan. Arterial hypertension and the hidden disease of the eye: diagnostic tools and therapeutic strategies. Nutrients, 14:2200, May 2022. URL: https://doi.org/10.3390/nu14112200, doi:10.3390/nu14112200. This article has 31 citations.

21. (urinatriana2024machinelearningand pages 16-17): Miguel Alberto Urina-Triana, Marlon Alberto Piñeres-Melo, Mirary Mantilla-Morrón, Shariq Butt-Aziz, Luisa Galeano-Muñoz, Sumera Naz, and Paola Patricia Ariza-Colpas. Machine learning and ai approaches for analyzing diabetic and hypertensive retinopathy in ocular images: a literature review. IEEE Access, 12:54590-54607, Jan 2024. URL: https://doi.org/10.1109/access.2024.3378277, doi:10.1109/access.2024.3378277. This article has 31 citations and is from a peer-reviewed journal.

22. (NCT07471971 chunk 1): Assessment of Hypertensive Retinopathy Using Convolutional Neural Network "RetinAIcheck". I.M. Sechenov First Moscow State Medical University. 2021. ClinicalTrials.gov Identifier: NCT07471971

23. (NCT01753648 chunk 1): Gerhard Garhofer. Non-invasive Measurement of Retinal Blood Flow Based on Vessel Analysis and Fourier Domain Optical Coherence Tomography in Patients With Hypertensive Retinopathy. Medical University of Vienna. 2015. ClinicalTrials.gov Identifier: NCT01753648

Artifacts

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