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Introduction Hypertension is a growing public health concern in sub-Saharan Africa, contributing significantly to cardiovascular morbidity and mortality. In conflict-affected regions such as eastern Democratic Republic of the Congo (DRC), fragile health systems and recurrent insecurity further exacerbate this burden. This study aimed to determine the prevalence of hypertension and identify associated factors among adults in the Nyiragongo Health Zone, North Kivu, DRC.Methods A cross-sectional survey was conducted among 786 adults (527 women, 259 men). Sociodemographic, clinical and lifestyle data were collected using standardised questionnaires. Blood pressure (BP) measurements followed international guidelines. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with hypertension.Results The mean age of participants was 36.2±14.8 years (range: 18–78 years), with women slightly younger than men (35.3±14.2 vs 38.1±15.6 years; p=0.017). The overall prevalence of hypertension was 36.1% (n=284), with 2.4% of hypertensive participants receiving treatment. BP increased with age for both sexes, with systolic and diastolic pressures higher in women than in men after 50 years. Multivariate analysis identified age >40 years (adjusted OR (aOR)=2.92 (95% CI 2.01 to 4.25); p<0.0001), alcohol consumption (aOR=1.69 (95% CI 1.09 to 2.63); p=0.020), suboptimal consumption of vegetables (aOR=1.50 (95% CI 1.07 to 2.10); p=0.019), family history of hypertension (aOR=1.71 (95% CI 1.26 to 2.35); p<0.0001) and obesity (aOR=1.72 (95% CI 1.02 to 2.91); p=0.043) as independently associated factors.Conclusions Hypertension is highly prevalent in the Nyiragongo Health Zone, with a substantial proportion of cases remaining untreated. Targeted community interventions promoting lifestyle modification, early detection and management are urgently needed to mitigate the cardiovascular burden in this population.