Background: Hypertension is a global concerned problem brings about a majority disability and mortality as well as in Thailand. Moreover, one of the sequalae among hypertensive patients is stroke or cerebrovascular accident (CVA) which an incidence rate is greater than the rate among general population. Nevertheless, there is lack of information indicating incidence rate and risk factors of CVA in Thai hypertensive patients. Objective: To evaluate incidence and risk factors of cerebrovascular accident among hypertensive patients Methodology: A retrospective cohort study was conducted in 2022 by recruiting 2578 hypertensive patients during 2011 – 2022 from Tha Wung hospital. Participants under 18 years old with previous CVA history before hypertension diagnosis were excluded from this study. The primary outcome of this research was the first CVA. For descriptive statistics, demographic data including the age of first hypertension diagnosis, gender, health insurance, and occupation were described in percent, mean and standard deviation. For analytic statistics, demographic data and predictive factors including BMI, uncontrolled hypertension, smoking status, alcohol consumption, diabetes mellitus, high cholesterol, and chronic kidney disease were calculated by a multivariate Cox Proportional Hazards regression model. Results: There were 83 confirmed new CVA cases among 2578 eligible participants with follow-up. The incident rate of CVA was 8.05 per 1000 person-years [95% CI: 6.49–9.99]. Risk factors of CVA among hypertensive patients were being male with adjusted HR (95% CI) of 1.86(1.09 - 3.15), age at hypertension diagnosis above 80 years old, 4.39(1.79 - 10.74), and current smoking, 2.41(1.04 - 5.55). Conclusions: CVA incidence among Thai hypertensive patients is more considerable than the normal population. A smoking cession program should be initially recommended to decrease the risk of CVA.