Background: Systemic hypertension is a major public health problem and a well‑recognized risk factor for cardiovascular and cerebrovascular diseases. The retinal vasculature provides a unique opportunity to directly observe microvascular changes related to systemic blood pressure. Hypertensive retinopathy reflects chronic vascular damage and may serve as an indicator of systemic vascular injury.

Objective: To assess the association between systemic hypertension and retinal vascular changes in adults and to evaluate the relationship between severity and duration of hypertension with retinal findings.

Methods: A cross‑sectional observational study was conducted among adult participants attending a tertiary care hospital. Participants were classified into hypertensive and normotensive groups based on blood pressure measurements and medical history. Detailed ophthalmic examination, including fundus evaluation, was performed to identify retinal vascular changes. Hypertensive retinopathy was graded according to the Keith–Wagener–Barker classification. Statistical analysis was carried out to determine the association between hypertension and retinal changes.

Results: Retinal vascular changes were significantly more common among hypertensive individuals compared to normotensive controls. The prevalence and severity of hypertensive retinopathy increased with longer duration and poorer control of blood pressure. Arteriolar narrowing was the most frequent retinal finding.

Conclusion: Systemic hypertension is strongly associated with characteristic retinal vascular changes. Regular retinal examination in hypertensive patients can aid in early detection of microvascular damage and may help prevent serious ocular and systemic complications.