AIM: To analyze whether alterations of voxel mirror homology connectivity (VMHC) values, as determined by resting-state functional magnetic resonance imaging (rs-fMRI), occur in cerebral regions of patients with hypertensive retinopathy (HR) and to determine the relationship between VMHC values and clinical characteristics in patients with HR. METHODS: Twenty-one patients with HR and 21 age-matched healthy controls (HCs) were assessed by rs-fMRI scanning. The functional connectivity between the hemispheres of the cerebrum was assessed by measuring VMHC, with the ability of VMHC to distinguish between the HR and HC groups assessed using receiver operating characteristic (ROC) curve analysis. Differences in the demographic and clinical characteristics of the HR and HC groups were analyzed by independent sample t-tests. The relationship between average VMHC in several brain areas of HR patients and clinical features was determined using Pearson correlation analysis. RESULTS: Mean VMHC values of the bilateral cuneus gyrus (BA19), bilateral middle orbitofrontal gyrus (BA47), bilateral middle temporal gyrus (BA39) and bilateral superior medial frontal gyrus (BA9) were lower in the HR than in the HC group. CONCLUSION: VMHC values can predict the development of early HR, prevent the transformation of hypertensive microangiopathy, and provide useful information explaining the changes in neural mechanism associated with HR.