A cross-sectional study of 1527 eyes (2977 eyes) in 1527 participants with a mean age of 70.04 ± 5.74 years (55% female) investigated retinal thickness (RT) measured by optical coherence tomography in people with COPD and hypertension. 49.8% of the participants had hypertension and 8.2% had COPD. Age caused RT thinning in all macular areas except the central one (p < 0.05). COPD was associated with thinning in the central, internal nasal, inferior external, and external nasal regions only in the nonhypertensive subgroup (p < 0.05). Hypertension increased the risk of thinning in the temporal internal region (OR = 1.249, 95% CI: 1.030–1.514) and superior external region (OR = 1.325, 95% CI: 1.092–1.608). Diastolic blood pressure (DBP) was positively correlated with intrinsic RT (β = 0.186–0.202, p < 0.01), systolic blood pressure (SBP) was not; in treated hypertensive patients only in the upper internal area. COPD and hypertension are independent risk factors for changes in RT with different effects in individual areas, antihypertensive treatment reduces the effect of DBP.