Background: Hypertensive retinopathy (HR) and retinal arteriosclerosis are established markers of microvascular damage in chronic hypertension, yet their role as independent predictors of left ventricular (LV) remodeling remains underexplored. Objective: This study investigated the systemic cardiovascular implications of HR and arteriosclerosis by correlating their severity with echocardiographic and electrocardiographic indices of LV structural and functional adaptation. Patients and Methods: In this cross-sectional analysis, 87 adults with chronic hypertension underwent comprehensive ophthalmologic evaluation (HR staged 0–4 via Scheie classification; arteriosclerosis graded 0–4), 2D/3D echocardiography, and electrocardiogram (ECG). Multivariate regression adjusted for age, sex, BMI, and hypertension duration was used to assess independent associations. Results: Advanced HR stages (3–4) demonstrated a dose-dependent relationship with concentric LV remodeling (p < /em><0.001) and elevated left ventricular mass index (LVMI) (>95 g/m²; Stage 4: 112±18 vs. Stage 0: 85±12, p < /em><0.001). Eccentric hypertrophy prevalence escalated from 5% (Stage 0) to 38% (Stage 4), paralleling prolonged hypertension duration (p < /em>=0.002). Retinal arteriosclerosis mirrored these trends, with Stage 4 linked to LVMI=118±20 g/m² (vs. Stage 0: 85±12, p < /em><0.001) and concentric remodeling (p < /em><0.001). ECG- Left ventricular hypertrophy (LVH) prevalence rose from 15% (Stage 0) to 85% (Stage 4, p < /em><0.001), reinforcing the systemic nature of hypertensive injury. Conclusion: Hypertensive retinopathy and arteriosclerosis are independent, dose-dependent predictors of adverse LV remodeling, reflecting shared pathways of microvascular and macrovascular dysfunction. These findings advocate for integrating retinal screening into routine hypertensive care to stratify cardiac risk and guide early therapeutic intervention, particularly in patients with advanced retinopathy (Stage 3–4) or arteriosclerosis.