Objective: To evaluate the additional value of funduscopy in the routine manag ement of patients with hypertension. Design: Systematic review. Participants: Ad ults aged 19 or more with hypertensive retinopathy. Data sources: Medline, Embas e, and the Cochrane Library from 1990. Review methods: Studies were included tha t assessed hypertensive retinopathy with blinding for blood pressure and cardiov ascular risk factors. Studies on observer agreement had to be assessed by two or more observers and expressed as a κstatistic. Studies on the association betwe en hypertensive retinopathy and hypertensive organ damage were carried out in pa tients with hypertension. The association between hypertensive retinopathy and c ardiovascular risk was carried out in unselected normotensive and hypertensive p eople without diabetes mellitus. Results: The assessment of microvascular change s in the retina is limited by large variation between observers. The positive an d negative predictive values for the association between hypertensive retinopath y and blood pressure were low (47%to 72%and 32%to 67%, respectively). Associ ations between retinal microvascular changes and cardiovascular risk were incons istent, except for retinopathy and stroke. The increased risk of stroke, however , was also present in normotensive people with retinopathy. These studies did no t adjust for other indicators of hypertensive organ damage. Conclusion: Evidence is lacking that routine funduscopy is of additional value in the management of hypertensive patients. Objective: To evaluate the additional value of funduscopy in the routine managment of patients with hypertension. Design: Systematic review. Participants: Ad ults aged 19 or more with hypertensive retinopathy. Data sources: Medline, Embas e, and the Cochrane Library from 1990 Studies methods include included tt assessed hypertensive retinopathy with blinding for blood pressure and cardiov ascular risk factors. Studies on observer agreement had to be assessed by two or more observers and expressed as a κstatistic. Studies on the association betwe en hypertensive retinopathy and hypertensive organ damage were carried out in pa tients with hypertension. The association between hypertensive retinopathy and c ardiovascular risk was carried out in unselected normotensive and hypertensive p eople without diabetes mellitus. Results: The assessment of microvascular change s in the retina is limited by large variation between observers. The positive an d negative predictive values ​​fo r the association between hypertensive retinopath y and blood pressure were low (47% to 72% and 32% to 67%, respectively). Associated aids between retinal microvascular changes and cardiovascular risk were incons istent, except for retinopathy and stroke. of stroke, however, was also present in normotensive people with retinopathy. These studies did not adjust for other indicators of hypertensive organ damage. Conclusion: Evidence is lacking that routine funduscopy is of additional value in the management of hypertensive patients.