Hypertensive retinopathy is a retinal microvascular manifestation of systemic arterial hypertension and serves as a critical indicator of end-organ damage. Chronic-elevated blood pressure induces progressive alterations in the retinal vasculature, including arteriolar narrowing, arteriovenous nicking, and increased vascular tortuosity. In more advanced stages, acute rises in blood pressure can lead to retinal hemorrhages, cotton-wool spots, hard exudates, and, in severe cases, optic disc swelling, collectively referred to as malignant hypertensive retinopathy. These changes reflect not only ocular damage but also systemic vascular compromise, particularly in the brain, heart, and kidneys. The pathophysiology involves vasospasm, endothelial dysfunction, and increased vascular permeability, resulting in ischemia and hemorrhage. Classification systems, such as the Keith-Wagener-Barker and Scheie grading systems, have historically been used to assess severity and guide prognosis, though modern imaging modalities such as optical coherence tomography (OCT) and fluorescein angiography have enhanced diagnostic precision. Clinically, hypertensive retinopathy may be asymptomatic, especially in early stages, making routine ophthalmologic evaluation critical in hypertensive patients. The presence of moderate-to-severe retinopathy is associated with a significantly increased risk of cardiovascular and cerebrovascular events. Management focuses on stringent blood pressure control to prevent progression and systemic complications. Early recognition of retinal changes plays a vital role in risk stratification and comprehensive care. As such, hypertensive retinopathy is not merely an ophthalmic finding but a window into systemic vascular health, emphasizing the interdisciplinary importance of its detection and management.