Background: Hypertension is a leading risk factor for cardiovascular disease worldwide. Low? and middle?income countries, including Nigeria, appear to be worst hit, with relatively higher number of cases and limited awareness, treatment, and control rates, in contrast with the trend in developed countries. The retina is the only site in the human body where blood vessels can be visualized directly with the help of an ophthalmoscope. Since hypertension has its effects on all the vessels of the human body, retinal examination and assessment of vascular changes can provide valuable information. Awareness of hypertensive retinopathy varies considerably in different regions and countries of the world.

Method: The study design was a hospital-based cross sectional descriptive survey of hypertensive adults aged 40 years and above, and of both sexes who were attending 21 health facilities in both urban and rural areas of Imo State, southeast Nigeria. The aim was to determine the prevalence and awareness of hypertensive retinopathy among the participants. Twenty one health facilities were sampled, with 382 participants.

Results: The prevalence of hypertensive retinopathy was 83.2% in the study, and was statistically significant (p=0.001). Awareness of hypertensive retinopathy stood at 20.7%, while 79.3% were unaware.

Conclusion: There is need for increased public health education to increase the awareness of hypertension and its complications. Hypertension control programmes need to be established in communities in the state, and more community-based screening programmes for cardiovascular disease risk factors and non-communicable diseases need to be carried out.