Among 296 HIV patients receiving antiretroviral therapy in Tanzania, 32.8% developed hypertension, with particularly elevated risks for those aged 55 and older (4.8-fold increase) and cigarette smokers (6.2-fold increase). Longer HIV diagnosis duration beyond 10 years tripled hypertension odds, while shorter ART treatment duration under 5 years was protective. Notably, only 10.8% of participants could correctly identify normal blood pressure levels, indicating severe knowledge gaps. This finding adds crucial epidemiological data to the growing recognition that HIV patients face dual cardiovascular and infectious disease burdens as antiretroviral therapies extend lifespans. The research underscores how traditional risk factors like age and smoking compound with HIV-specific factors such as chronic inflammation and immune dysfunction. For HIV care providers, these results suggest integrating routine blood pressure monitoring and cardiovascular risk assessment into standard HIV treatment protocols. The study's cross-sectional design limits causal inferences, and generalizability beyond Tanzania requires validation. As this is a preprint awaiting peer review, these prevalence estimates and risk associations may be refined through the editorial process.