Background: Hypertension (HTN) affects cardiovascular, renal and neurological systems. The poorly controlled blood pressure may also cause structural and functional retinal damage. Objective: To assess changes in foveal avascular zone (FAZ) and macular vessel density using Optical Coherence Tomography Angiography (OCTA) in hypertensive patients. Patients and Methods: This case control observational study was performed on 120 eyes, divided into 3 groups. Group A: 40 eyes of 26 patients with HTN for more than 10 years, group B: 40 eyes of 22 patients with HTN less than 10 years, and group C: 40 eyes of 20 normal subjects with completely normal ophthalmological examination. All participants underwent OCTA. Results: There was no significant variation in age, gender or FAZ between the three studied groups. Superficial capillary plexuses in parafovea, parafovea superior hemi, parafovea inferior hemi, perifovea, perifovea superior hemi, and perifovea inferior hemi were considerably higher in group C than in group A (p =0.002, 0.001, 0.011, 0.014, 0.041, and 0.002, respectively) and group B (p <0.001). Deep capillary plexuses in parafovea, parafovea superior hemi, parafovea inferior hemi, perifovea, perifovea superior hemi, and perifovea inferior hemi were considerably higher in group C than in group A (p <0.001), and group B (p =0.004, 0.004, 0.003, 0.002, 0.001, and 0.003, respectively). No significant difference were observed in the studied parameters between group A and B. Conclusion: Eyes of HTN patients have lower macular vessel densities (superficial and deep ) compared to those of healthy controls. The duration and control of hypertension didn't account any substantial differences between the two groups of hypertensive patients.