Background: Urolithiasis and hypertension are prevalent and clinically significant conditions in the Middle East, both influenced by shared metabolic and environmental risk factors. Understanding the potential association between them is important for guiding prevention strategies. Objective: To explore the relationship between urolithiasis and hypertension in a sample of Iraqi adult patients. Methods: A cross-sectional observational study was conducted at Alkindy Teaching Hospital, Baghdad, from September 2024 to March 2025. Participants included 237 patients with confirmed urinary tract stones and 244 controls confirmed to be stone-free, matched for age and sex. Exclusion criteria included secondary hypertension, chronic kidney disease (stage 3 or higher), pregnancy, and metabolic or hormonal disorders likely to alter the blood pressure. Blood pressure status was determined via history and repeated measurements. BMI and demographic data were collected. Statistical analysis included Chi-square, Mann-Whitney U, and logistic regression models. Results: Hypertension was significantly more prevalent in the urolithiasis groupan in the controls. Patients with urolithiasis also had significantly higher BMI. However, after adjusting for age and BMI, urolithiasis was no longer significantly associated with hypertension (OR = 0.63; 95% CI: 0.39–1.01; p=0.056), while both age and BMI remained significant predictors of hypertension (p<0.001). Conclusions: Although a higher prevalence of hypertension was observed among patients with urolithiasis, this association was not statistically significant after adjusting for age and BMI. These findings suggest that shared risk factors, particularly obesity, may mediate the observed relationship.