Background and objective: The indigenous groups are considered minority populations, primarily residing in rural areas. Cardiovascular disease stands as the leading cause of mortality, affecting native populations as well. This study aims to compare the overall survival (OS) rates among patients diagnosed with hypertension (HTN) in four Colombian departments where the population concentration of indigenous groups is over 10% compared to departments where it is less than 1%. Methods: Longitudinal retrospective cohort study. Population: Indigenous adults diagnosed with HTN from July 1st, 2014, to June 30 th, 2015, from the National Registry of Chronic Kidney Disease (NRCKD). The follow-up period was until July 30, 2023. We grouped indigenous communities according to their population concentration calculated by the Observatory of the Colombian Presidential Program for Human Rights. The probability of global survival from the date of diagnosis was estimated using Kaplan-Meier analysis. An unadjusted Royston Parmar flexible regression model was fitted. Right-censoring was defined as abandonment or completion of follow-up without death occurring. Results: 67,353 indigenous prevalent cases were identified from July 1st, 2022 to June 30th, 2023, representing an HTN prevalence of 2.76%. Among them, 48.90% are in Cauca, Nariño, La Guajira, and Córdoba. Natives of Nariño registered a higher proportion of GFR stages 3 and 4, calculated using the CKD-EPI formula, compared to departments with a concentration of less than 1% (48.30% and 3.15% vs. 8.08% and 0.45% respectively). 2.600 cases were included in the survival analysis. Natives residents from Nariño and Cauca had the highest risk of all-cause mortality (HR = 7.66; 95% CI 3.33 – 17.59 and HR = 7.36; 95% CI 3.26 – 16.61) compared to groups living in departments with <1% concentration. Conclusions: In the Colombian health system, the hazard of all-cause mortality is higher for indigenous individuals with HTN living in Nariño and Cauca compared to those living in departments with less than 1% of the indigenous population.