Purpose To quantify early changes of macular microvascular density, complexity, and peripapillary vessel caliber in hypertension using optical coherence tomography angiography (OCTA). Methods Hypertension (137 eyes) and healthy eyes (79 eyes) as control were involved in this prospective observational study. Indices of the microcirculation included vessel density (VD), skeleton density (SD), vessel diameter index (VDI), fractal dimension (FD) and foveal avascular zone (FAZ) of superficial retinal layer (SRL) and deep retinal layer (DRL), and peripapillary vessel calibers. The correlation of these indices with mean arterial pressure (MAP) and ocular perfusion pressure (OPP) was analyzed. Results Mean VD of DRL, SD of SRL and DRL, and FD of SRL and DRL were significantly reduced in the macula of hypertensive eyes (all P  < 0.01). Meanwhile, hypertensive eyes had margin results of narrower peripapillary arteriolar caliber ( P  = 0.04). No significant finding was demonstrated on VD of SRL, VDI and FAZ of SRL and DRL, peripapillary total vascular caliber, and peripapillary venal caliber (all P  > 0.05). SD and VD of the DRL correlated negatively with MAP (both R  = − 0.152, P  = 0.03). Conclusion OCTA algorithms may provide an additional inexpensive tool to aid in the preclinical assessment of hypertensive subject.