ABSTRACT Introduction: Hypertension is an emerging concern among people living with HIV (PLHIV) on antiretroviral therapy (ART), with limited data from Tanzania. This study aimed to determine the prevalence and determinants of hypertension among PLHIV on ART. Methods: A cross sectional study was conducted at Mwananyamala Regional Referral Hospital, Tanzania, in July 2024. This study enrolled 296 PLHIV on ART for >6 months using simple random sampling. Data on sociodemographic characteristics, HIV related factors, and hypertension knowledge were collected through structured questionnaires. Blood pressure and body mass index (BMI) were measured. Bivariate and multivariate logistic regression analyses assessed associations between HIV related factors and hypertension (defined as Blood Pressure ≥ 140/90 mmHg or use of antihypertensive medication). Results: The prevalence of hypertension was 32.8%. Longer duration of HIV diagnosis (1 to 5 years: adjusted odds ratio [aOR] 5.119, 95% CI 1.772 to 14.787, p=0.003; 6 to 10 years: aOR 3.738, 95% CI 1.568 to 8.910, p=0.003) and higher CD4 counts (≥500 cells/mm3: aOR 11.505, 95% CI 1.287 to 102.853, p=0.029; 350 to 499 cells/mm3: aOR 12.173, 95% CI 1.389 to 106.670, p=0.024) were associated with increased hypertension risk. Shorter ART duration (<1 year: aOR 0.122, 95% CI 0.016 to 0.935, p=0.043) reduced risk. Traditional risk factors (age >35 years, overweight/obesity, family history of hypertension, physical inactivity) also increased hypertension risk. Knowledge of hypertension was moderate (53.85%), with 21.6% demonstrating good knowledge. Conclusions: Hypertension is prevalent among PLHIV on ART in Tanzania, driven by HIV related and traditional risk factors. Integrated screening and education within HIV care are critical. Keywords: HIV, Hypertension, Antiretroviral Therapy

The authors have declared no competing interest.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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