BACKGROUND: While antiretroviral therapy (ART) reduces AIDS-related morbidity and mortality, it is unclear if prolonged ART use among people living with HIV (PLHIV) increases the risk of hypertension. OBJECTIVE: We assessed the association between the duration of ART use and hypertension in the Rakai Community Cohort Study (RCCS). DESIGN: We conducted a cross-sectional study among PLHIV (35-49 years old) on ART in the RCCS who were surveyed between August 2016 and May 2018. METHODS: Systolic and diastolic blood pressure (BP) was measured twice, averaged, and classified as any hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg), severe or worse hypertension (systolic BP ≥ 160 mmHg or diastolic BP ≥ 100 mmHg), or hypertensive crisis (systolic BP ≥ 180 mmHg or diastolic BP ≥ 110 mmHg). ART duration was categorized as short (0-2 years), moderate (> 2-5 years), or prolonged (> 5 years). We used log-binomial regression to estimate the adjusted prevalence ratio (adjPR) of hypertension associated with ART duration. RESULTS: A total of 1,144 PLHIV on ART with documented BP information were identified in the RCCS, of whom 173 (15.1%) had any hypertension, 64 (5.6%) had at least severe hypertension, and 44 (3.8%) had hypertensive crisis. After controlling for age, sex, and body mass index, the prevalence of having all stages of high BP was increased by at least 42% in participants with more than five years of ART use (any hypertension adjPRs = 1.42 [95% CI = 0.99-2.03]; severe hypertension adjPRs = 1.79 [95% CI = 1.01-3.15]; and hypertensive crisis adjPRs = 2.56 [95% CI = 1.14-5.77]). CONCLUSIONS: PLHIV on long-term ART have a higher burden of hypertension, highlighting the need for enhanced screening and integrated management in HIV programs.