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IntroductionHypertension has emerged as a significant comorbidity among people living with Human Immunodeficiency Virus (HIV). However, the prevalence and determinants of hypertension in Ethiopia remain inconsistent across studies.MethodsA systematic search of PubMed, Science Direct, Cochrane Library, Hinari, and Google Scholar was conducted following PRISMA 2020 guidelines. Both published and grey literature conducted in Ethiopia were included. The Newcastle Ottawa scale was used to assess the quality of included studies.ResultsPooled prevalence of hypertension among people living with HIV in Ethiopia was 22% (95% CI: 17.0-28.0). Factors significantly associated with hypertension among people living with HIV included physical inactivity (AOR=2.73; 95% CI: 2.05-3.41), excessive alcohol drinking (AOR=3.01; 95% CI: 1.41-4.61), and ART duration ≥5 years (AOR=2.50; 95% CI: 1.46-3.54).ConclusionHypertension affects approximately one in five people living with HIV in Ethiopia. Physical inactivity, alcohol use and long-term ART were significantly associated with Hypertension.