Hypertension has been implicated as a strong predictive factor for poorer outcomes in patients undergoing various vascular procedures. However, limited research is available that examines the effect of uncontrolled hypertension on outcomes after carotid revascularization. We aimed to determine which carotid revascularization procedure yields the best outcome in this patient population. We studied patients undergoing Carotid Endarterectomy (CEA), Transfemoral Carotid Artery Stenting (TFCAS), or Transcarotid Artery Revascularization (TCAR) from April 2020 to June 2022 using data from Vascular Quality Initiative (VQI). Patients were stratified into two groups: those with controlled hypertension (cHTN) and those with uncontrolled hypertension (uHTN). Patients with cHTN were those with HTN treated with medication and a blood pressure <130/80. Patients with uHTN had a blood pressure >130/80. Our primary outcomes were in-hospital stroke, death, myocardial infarction (MI), and 30-day mortality. Our secondary outcomes were postoperative hypotension/hypertension, reperfusion syndrome, prolonged length of stay (PLOS; >1 day), stroke/death and stroke/death/MI. We used logistic regression models for the multivariate analysis. A total of 34,653 CEA (uHTN= 11,347, 32.7%), 8,199 TFCAS (uHTN=2,307, 28.1%), and 17,309 TCAR (uHTN=4,990, 28.8%) patients were included in this study. There was no significant difference in age between cHTN and uHTN patients for each carotid revascularization procedure. However, compared to cHTN, patients with uncontrolled HTN had significantly more comorbidities. Uncontrolled HTN was associated with an increased risk of combined in-hospital stroke/death/MI following CEA (aOR=1.56 [95% CI: 1.30-1.87]; p<0.001), TFCAS (aOR=1.59 [95% CI: 1.21-2.08]; p<0.001) and TCAR (aOR=1.39 [95% CI: 1.12-1.73]; p=0.003) compared to controlled HTN. Additionally, uHTN was associated with PLOS following all carotid revascularization methods. For the sub-analysis of patients with uHTN, TFCAS was associated with an increased risk of stroke (aOR=1.82 [95% CI: 1.39-2.37]; p<0.001), in-hospital death (aOR=3.73 [95% CI: 2.25-6.19]; p<0.001), reperfusion syndrome (aOR=6.24 [95% CI: 3.57-10.93]; p<0.001), and extended LOS (aOR=1.87 [95% CI: 1.51-2.32]; p<0.001) compared to CEA. There was no statistically significant difference between the outcomes of TCAR compared to CEA. The results from this study show that patients with uncontrolled hypertension are at a higher risk of stroke and death postoperatively compared to patients with controlled hypertension; highlighting the importance of treating HTN before undergoing elective carotid revascularization. Additionally, in patients with uHTN, TFCAS yields the worst outcomes while CEA and TCAR proved to be the safer interventions. Uncontrolled hypertensive patients with symptomatic carotid disease treated with CEA or TCAR have better outcomes compared to those treated with TFCAS.