Analysis of 26,541 hypertension patients reveals alarming retention patterns: 18% never returned after initial diagnosis, and among those who did return, only 16% remained engaged at 36 months. The study found stark racial disparities, with Black, Hispanic, and other non-White patients significantly more likely to drop out of care, while older patients, women, and those with comorbidities like diabetes showed better retention. Blood pressure control among retained patients improved dramatically from 11% at baseline to 64% at 12 months, highlighting the critical importance of sustained engagement. These findings illuminate a fundamental weakness in hypertension management that likely contributes to cardiovascular health disparities. The retention crisis particularly affects minority populations who already face higher cardiovascular risks. For health systems, this suggests urgent need for targeted retention strategies, especially in the first six months when dropout is steepest. The data also validates that sustained primary care engagement can achieve good blood pressure control rates. However, as an unreviewed preprint, these findings require peer review confirmation before informing clinical guidelines or policy decisions.