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The finding that is most suggestive of hypertension is optic atrophy. This condition can occur as a result of chronic elevated blood pressure, which can damage the optic nerve over time. Hypertension can lead to various ocular complications, and damage to the optic nerve is one of the critical consequences that might result from prolonged high blood pressure.

Optic atrophy signifies a deterioration of the optic nerve fibers, which can be visually assessed during an eye examination. This deterioration is often linked to systemic conditions, particularly the vascular damage caused by hypertension. Identifying optic atrophy during a patient evaluation may prompt further investigation into underlying blood pressure issues.

In contrast, while conditions like retinal detachment and preretinal hemorrhage can be associated with hypertensive retinopathy, they are not as definitive in suggesting hypertension as optic atrophy. Macular degeneration is primarily related to aging and does not have a direct correlation with hypertension. These distinctions help underscore why optic atrophy stands out as a key indicator suggestive of hypertension.