Objectives: To investigate the characteristics of hearing loss and hearing threshold at different frequencies in hypertensive patients. To analyze the factors related to hearing loss and hearing threshold at different frequencies in hypertensive patients. Design：Observational Studies. From inpatient ward, clinical, biological and hospital data were collected. Setting：Single center population-based observational study. Participants：We considered 517 patients (1034 ears),either with hypertension or without hypertension. Main outcome measures：We considered the proportion of hearing loss, the average hearing threshold, low-frequency hearing threshold, medium-frequency hearing threshold, and high-frequency hearing threshold. The risk factors related to hearing loss, mean hearing threshold, low-frequency hearing threshold, medium-frequency hearing threshold, and high-frequency hearing threshold were searched. Results: Compared with the non-hypertensive group, the proportion of hearing loss in the hypertensive group was higher ( P < 0.05). After including risk factors of cardiovascular disease and ambulatory blood pressure parameters in the regression model, the factors related to hearing loss included Albumin creatinine ratio (ACR) and the standard deviation of 24-hour systolic blood pressure (24h-SSD). ACR, 24h-SSD, and day systolic blood pressure (Day SBP) were associated with mean hearing threshold, low-frequency hearing threshold, medium-frequency hearing threshold, and high-frequency hearing threshold. The area under the receiver operating characteristic curve of ACR+24h-SSD for hearing loss was 0.873 with a sensitivity of 86.73%, specificity of 90.52%, and 95% confidence interval of 0.821–0.914. Thus, ACR combined with 24h-SSD had a high predictive efficiency for hearing loss. Conclusion: Hypertension may be a cause of hearing loss, and the related factors include ACR and 24h-SSD.