This review discusses the current understanding of hypertensive retinopathy. It describes the pathomorphology of hypertensive retinopathy according to its grade. The main approaches to classification and elements of pathophysiology are briefly considered, and the clinical significance of hypertensive changes in the fundus is examined. The characteristics of traditional and innovative methods of assessing the retina, and their accuracy in predicting the course of hypertension is discussed. Data from our investigations with scanning laser ophthalmoscopy and optical coherence tomographic angiography are presented. Our data show that uncomplicated hypertension in middle-aged men and women is accompanied by a distinct reduction in the diameter of the retinal arterioles and an expansion of the foveal avascular zone at the level of the superficial capillary plexus of the retina. We review the literature and present the results of our observations, demonstrating the retinoprotective benefits of antihypertensive therapy.