Introduction: Hypertension is a major etiological factor in hypertensive retinopathy, a microangiopathy resulting from structural and functional retinal vascular alterations induced by chronic blood pressure elevation. In sub-Saharan Africa, this complication remains frequent, yet data from Niger, particularly from Zinder, are still limited. This study aimed to describe the epidemiological and clinical characteristics of hypertensive retinopathy at the National Hospital of Zinder and to identify the factors associated with its occurrence. Methodology: A descriptive cross-sectional study with prospective data collection was conducted over a 10-month period in the Ophthalmology Department of the National Hospital of Zinder. Hypertensive patients aged 18 years or older were consecutively included after confirmation of hypertension based on a documented history of hypertension, ongoing antihypertensive treatment, or elevated blood pressure measured during clinical evaluation according to standard diagnostic thresholds. All included patients underwent a complete ophthalmologic examination with funduscopy after pupillary dilation. Hypertensive retinopathy was graded using the Kirkendall classification, based on the severity of retinal arteriolar narrowing, arteriovenous crossing changes, hemorrhages, exudates, and optic disc edema. Results: A total of 152 hypertensive patients were initially enrolled, among whom 146 completed fundus examination; six patients were not analyzed because the examination could not be performed or interpreted adequately. Fundus abnormalities were found in 79 patients (54.11%), including 63 cases of hypertensive retinopathy (43.15%). The mean age was 51.82 ± 13.05 years, and females predominated (58.22%). Most patients lived in urban areas (78.77%) and had no formal education (36.99%). Among the 120 patients receiving antihypertensive treatment, 71 had poor adherence, corresponding to 59.17%. According to the Kirkendall classification, stage 1 accounted for 60.32% of cases, followed by stage 2 (30.16%) and stage 3 (9.52%). Older age, male sex, diabetes, and poor treatment adherence were significantly associated with hypertensive retinopathy. Conclusion: Hypertensive retinopathy is common at the National Hospital of Zinder and mainly occurs in patients with poor treatment adherence and cardiometabolic comorbidities. Early screening, improved blood pressure follow-up, and better therapeutic adherence may help reduce retinal and systemic complications.