Aims: Cardiovascular disease is the leading cause of mortality and morbidity in the western world and has reached epidemic proportions. The incidence of congestive heart failure (CHD) and hypertension is also rising rapidly in many of the affluent Arab nations and cardiovascular diseases continue to be a leading cause of morbidity and mortality among adult Qataris and Asians residing in Qatar. Objective: The objective of this study is to assess the effect of hypertension among patients admitted to hospital in Qatar with CHD and to identify risk factors that contribute to the development of CHD in hypertensive subjects. Design: This is a retrospective cohort study. Setting: Hamad General Hospital, Hamad Medical Corporation. Subjects: All patients who were hospitalized with CHD with or without hypertension in the Hamad General Hospital, State of Qatar, from 1991 to 2001. Methods: The diagnostic classification of definite CHD was made in accordance with criteria based on the International Classification of Disease, ninth revision (ICD-9). Result: A total of 20856 patients were treated during the 10-year period; 8446 were Qataris. Among them, 60% were males and 40% females. Among the total patients (3713) hospitalized with CHD, 1744 (46.9%) had hypertension. Furthermore, the incidence of hypertension was slightly higher in males than in females (56.4 vs 43.6%). A statistically significant difference was found between hypertensive and non-hypertensive cases with diabetes mellitus and angina. Hypertensive subjects were more likely to have diabetes (p < 0.001) and angina (p < 0.030). The mortality rate of CHD patients with hypertension was higher among Qataris than among non-Qataris (p < 0.038). Conclusion: Hypertension was the most common risk factor for CHD; it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier detection of elevated blood pressure and its control are likely to offer the greatest promise for reducing the incidence of CHD and its associated mortality.