Background: Hypertension is a chronic condition driven by endothelial dysfunction, inflammation, and oxidative stress, all of which contribute to measurable hematological changes and abnormalities. Objective:The aim of this study was to assess hematological abnormalities and their associated factors among adult hypertensive patients attendingspecialized hospitals in Bahir Dar, Northwest Ethiopia. Methods: A comparative cross-sectional study was conducted involving 161 hypertensive patients and 161 age- and sex-matched normotensive controls. The study was done at Felege Hiwot Comprehensive Specialized Hospital and Tibebe Ghion Specialized Hospital from February 23 to April 30, 2026. Socio-demographic and clinical data were collected by face-to-face interviews. 4 mL of venous blood was collected into EDTA tubes and analyzed by Mindray BC-5150 automated hematology analyzer. Data were entered into EpiData version 4.7 and analyzed using SPSS version 27. Independent sample t-test and Mann-Whitney U test were used to compare hematological parameters. Bivariable and multivariable logistic regression analysis were used to identify factors associated with hematological abnormalities. A p-value of ≤ 0.05 was considered statistically significant. Results:White blood cell(6.56, 5.84; p = 0.001), neutrophil(3.79, 3.15; p = 0.001), neutrophil-to-lymphocyte ratio (1.92,1.50; p = 0.001), platelet(274.77, 260.05; p = 0.036), platelet-to-lymphocyte ratio (138.84, 123.35; p = 0.028), red cell distribution width-coefficient of variation (13.75, 13.15; p = 0.001)red cell distribution width-standard deviation(42.75, 41.88 ; p = 0.002)were significantly higher in hypertensivesthan normotensives. In contrast, they had significantly lower lymphocyte(1.99, 2.08; p = 0.041) and red blood cell (5.09, 5.24; p = 0.027). Anemia was the most common hematological abnormality (23%) among hypertensives, associated with age of ≥ 60 and obesity, while leukocytosis was associated with overweight and obesity. Conclusion:Hypertensionis coupled with alterations in hematological parameters.Association of anemia with older age and obesity suggests that these groups could be particularly vulnerable to hematological abnormalities. Similarly, association of overweight and obesity to leukocytosiscould indicate excess adiposity may contribute to inflammatory changes in hypertensivepatients.