Aim: The study aimed to compare the histopathological changes in ocular and uterine tissues in women with systemic hypertension, focusing on vascular and stromal alterations, to elucidate organ-specific responses to prolonged hypertensive stress. Materials and Methods: This retrospective study included 120 hypertensive women aged 40–65 years, divided into two groups: Group A (ocular tissues, n = 60) and Group B (uterine tissues, n = 60). Tissue samples were analyzed for vascular changes (endothelial thickening, intimal hyperplasia, hyalinization) and stromal alterations using hematoxylin and eosin staining. Quantitative and qualitative histopathological features were assessed, and logistic regression analysis identified predictors of stromal alterations. Statistical significance was set at p< 0.05. Results: The baseline characteristics were comparable between the groups. Endothelial thickening was observed in 75.00% of ocular tissues and 66.67% of uterine tissues (p = 0.33), while intimal hyperplasia was more prevalent in ocular tissues (83.33% vs. 70.00%; p = 0.08). Stromal alterations were significantly more frequent in uterine tissues (80.00% vs. 53.33%; p = 0.004), with higher stromal fibrosis scores (6.80 ± 1.70 vs. 4.20 ± 1.30; p< 0.001). Vessel wall thickness was also significantly greater in uterine tissues (15.10 ± 3.20 μm vs. 12.30 ± 2.40 μm; p< 0.001). Logistic regression identified duration of hypertension (OR: 1.12, p< 0.001), vessel wall thickness (OR: 1.25, p< 0.001), and stromal fibrosis score (OR: 1.30, p< 0.001) as key predictors of stromal alterations. Conclusion: The study revealed significant differences in histopathological changes between ocular and uterine tissues in hypertensive women. While vascular changes were evident in both tissues, uterine tissues demonstrated more extensive stromal alterations and fibrosis. These findings underscore the organ-specific impact of hypertension, emphasizing the need for targeted management strategies.