Abstract Introduction: Hypertensive heart disease (HHD) is a major contributor to cardiovascular morbidity and mortality in Southeast Asia, yet comparative evidence between neighboring populations with different healthcare systems remains limited. Aim: To compare the prevalence of HHD and identify its independent determinants among hypertensive patients in Makassar, Indonesia, and Kuala Terengganu, Malaysia. Material and Methods: A retrospective cross-sectional study included 600 adults with hypertension (300 from Makassar and 300 from Kuala Terengganu) treated at five tertiary hospitals between January 2021 and December 2024. HHD was defined as hypertension-related left ventricular hypertrophy, heart failure, or atrial fibrillation. Independent variables included age, sex, body mass index, smoking, diabetes mellitus, hypertension duration, and access to guideline-directed medical therapy. Multivariable logistic regression was performed to identify predictors. Results: HHD prevalence was significantly higher in Makassar than Kuala Terengganu (41.7% vs. 33.0%; p=0.027). Older age (aOR 1.04; 95% CI 1.02–1.07), longer hypertension duration (aOR 1.08; 95% CI 1.05–1.11), diabetes mellitus (aOR 1.82; 95% CI 1.27–2.61), obesity (aOR 1.59; 95% CI 1.12–2.26), and absence of guideline-directed therapy (aOR 2.11; 95% CI 1.43–3.12) were independent predictors. Male sex predicted HHD only in Makassar, whereas smoking was significant only in Kuala Terengganu. Conclusion: HHD burden remains substantial in both cities despite differences in healthcare access. Universal cardiometabolic risk factors coexist with region-specific determinants, highlighting the need for context-adapted hypertension prevention and management strategies across Southeast Asia. Keywords: Hypertensive heart disease; cross‑sectional study; retrospective; comparative epidemiology; hypertension determinants; cardiovascular risk score
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