Background: Stroke is becoming a major public health problem and the commonest causes of morbidity and mortality among non-communicable diseases in the world. Globally, one in three adults has hypertension, a condition which causes 51% of all deaths from stroke. Hypertension is the most common and strongest modifiable risk factor for stroke, and results 13.2% for the incidence of stroke. There are other various factors which are not identified by previous studies. Objective: - To assess the incidence of stroke and its predictors among hypertensive patients in Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia 2021. Methods: - A hospital based retrospective follow up study design was conducted among 583 hypertensive patients card that registered from January1st, 2018 to December 30th, 2020 and followed up to February 30th, 2021. Data collected from patient’s card were entered to Epi-data version 3.1 and exported to Stata version 14. Kaplan Meir curve and log rank test were used to check survival and difference. Cox proportional hazards regression model was used to determine the adjusted hazard ratio for predictors with 95% CI, and P-value <0.05 was used to declare statistical significance. The assumptions were assessed by the global test. Results: - Out of 583 hypertensive patients 300 (51.5%) were male and about 335(57.46%) were from urban area. Half of patients were between the age of 45 and 65 years. From 583 hypertensive patients 106 (18.18%) [95% CI: 0.15- 0.2] developed stroke. The overall incidence rate was 1 per 100 person-years (95% CI: 0.79-1.19). Comorbidities (AHR: 1.88, 95% CI: 1.0-3.5), un controlled systolic blood pressure (AHR: 2, 95% CI: 1.21-354), un controlled diastolic blood pressure (AHR:1.9, 95% CI: 1.1- 3.57), alcohol consumption (AHR=2.04, 95%CI: 1.2-3.49), age45-65 (AHR=10.25, 95%CI: 7.47-11.1), follow up frequency [AHR=2.73, 95%CI: 1.2- 6.2] and drug discontinuation (AHR=2.05,95% CI: 1.26-3.35) were independent predictors for the incidence of stroke among hypertensive patients. Conclusion and recommendations: The incidence of stroke among hypertensive patients was high and various modifiable and non-modifiable risk factors were contributed for its incidence. This study recommends awareness about blood pressure and blood sugar level control, giving priority to comorbid patients and patients with advanced stage of hypertension, giving health education about behavioral risks and drug adherence. Key words: Incidence, stroke and hypertension, Felege Hiwot referral hospital, Ethiopia