Hypertension (HT) increases the risks of major cardiovascular events and affects a majority of elderly populations. Thus, blood pressure control is the mainstay for prevention of cardiovascular diseases. However, there is only a limited number of parameters for management of HT. This study was performed on consecutive patients between the ages of 35 and 70 years with normotension (NT) and HT in order to determine the possible consequences of HT on retinal vasculature and to avoid debility-induced weight loss. We studied 120 patients (64 females, 54.3 +/- 9.3 years) with NT and 147 (81 females, 57.3 +/- 11.0 years) with HT. No case of grade III or IV hypertensive retinopathy (HR) was detected in the groups. Although the prevalences of grades I and II HR were higher and grade 0 HR was lower in the hypertensive group, respectively (P < 0.001 for all), differences according to obesity, diabetes mellitus, hypertriglyceridemia (P < 0.001 for all), and dyslipidemia (P < 0.01) were also significant between the 2 groups. Therefore, only 18.3% (27 cases) of the hypertensives, even in whom the effect of aging could not be excluded, had HT only in the absence of any other risk factor of atherosclerosis. Despite the relatively higher specificities of grades III and IV HR for HT, particularly for hypertensive crisis, funduscopic examination has limited benefit in the management of HT due to the very low prevalences of grades III and IV HR, the multifactorial backgrounds of grades I and II HR, and the association of the multiple risk factors of atherosclerosis in a majority of the hypertensive cases.