The aim of the study was to assess the relationship between hypertensive target organ damage and vessel density (VD), foveal thickness, thickness of retinal nerve fiber layer, ganglion cell complex, and foveal avascular zone (FAZ) using optical coherence tomography angiography in a nonselected group of hypertensive children. One hundred fifty-seven children (56 girls) in mean age 14.9±2.9 years, in whom arterial hypertension was ultimately diagnosed were included in the study. FAZ, whole, fovea, parafovea superficial VD, whole, fovea, parafovea deep VD, foveal thickness, retinal nerve fiber layer, and ganglion cell complex were taken into analysis. Both absolute and standardized values of carotid intima-media thickness correlated with the larger FAZ area ( P =0.035, r =0.17; P =0.01, r =0.2, respectively). Subjects with increased carotid intima-media thickness had significantly larger FAZ ( P =0.024), reduced fovea superficial VD ( P =0.039), and foveal thickness ( P =0.007). Left ventricular hypertrophy and increased carotid-femoral pulse wave velocity were not associated with optical coherence tomography angiography parameters. Multiple linear regression revealed that the only determinant of FAZ and foveal thickness was higher carotid intima-media thickness–SD score, and for fovea superficial VD, the only determinant was central systolic blood pressure. In conclusion, hypertensive children present with signs of remodeling of microcirculation and decreased neural layer of retina associated with hypertensive macrocirculation remodeling expressed as increased carotid intima-media thickness and elevated central systolic blood pressure.