Background: Hypertension is the leading cause of preventable deaths globally, yet reports on its burden and risk factors in rural Sub-Saharan Africa have been inconsistent. This study aimed to assess the prevalence, awareness, and factors associated with hypertension among adults in a rural community in southwestern Uganda. Methods: A baseline survey was conducted in Ngango, Mbarara district, involving adults aged 18-79 from eleven villages. Research assistants and community health workers enrolled consenting participants from their homes using the WHO STEPS questionnaire, gathering demographic, behavioral characteristics (e.g., tobacco and alcohol use), and lifestyle factors including dietary habits and physical activity. Blood pressure (BP) readings were taken three times. Hypertension was defined as BP ≥140/90 mmHg or self-reported use of antihypertensive medication. We used logistic regression to identify factors associated with hypertension. Results: A total of 953 adults were enrolled, with a median (IQR) age of 43 (30-57) years, 61.5% female and only 43.5% recalled ever having a BP measure. The prevalence of hypertension was found to be 27.3% with 61.5% unaware of their condition. Only 27.7% receiving treatment and 65.3% had controlled BP. Despite 66.8% reporting good physical activity, 63.7% were overweight. Key factors associated with hypertension included being over 40 years old (OR 2.26), consuming fewer than three servings of fruits or vegetables weekly (OR 1.62), and being overweight or obese (OR 1.57 and OR 2.73, respectively). Conclusion: The prevalence of hypertension in rural southwestern Uganda is high, highlighting the need for targeted interventions, particularly in a relatively young and physically active population