Objective: Lipoprotein(a) [Lp(a)] has been shown to be a significant risk factor for cardiovascular disease (CVD) in the general population. However, its association with CVD risk in patients with hypertension remains unclear. This study aimed to compare the cardiovascular risk profiles of hypertensive patients with Lp(a) levels above and below 30 mg/dL. Design and method: This retrospective study included 34,280 consecutive hypertensive patients from a single center. Patients were divided into two groups based on their Lp(a) levels: Group 1 had 25,719 patients with Lp(a) < 30 mg/dL, and Group 2 had 8,561 patients with Lp(a) > 30 mg/dL. Stroke, cerebrovascular accident (CVA), transient ischemic attack (TIA), acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty were compared between the two groups. Furthermore, risks such as Stroke risk, HeartScore, InterHeart, 5-year risk, 10-year risk, and deep vein thrombosis (DVT) risk were also compared. Results: In the univariate analysis Group 2 (Lp(a) > 30 mg/dL) had significantly higher stroke rate (OR = 0.52, 95% CI [0.49, 0.63], p < 0.001), CVA (OR = 0.49, 95% CI [0.43, 0.55], p < 0.001), TIA (OR = 0.58, 95% CI [0.54, 0.63], p < 0.001), AMI (OR = 0.56, 95% CI [0.51, 0.63], p < 0.001), CABG (OR = 0.43, 95% CI [0.37, 0.52], p < 0.001) and PTCA (OR = 0.46, 95% CI [0.38, 0.55], p < 0.001) compared to Group 1 (Lp(a) < 30 mg/dL). Risk scores (Stroke risk, Heartscore, InterHeart, 5-year risk, 10-year risk and DVT risk) were also included in the univariate analysis where the difference is considered to be extremely statistically significant (p < 0.01). In the multivariate regression analysis the Lp(a) was the dependent variable and age, gender, glucose levels and total cholesterol levels were the independent variables. The correlation between the variables remained significant (p < 0.001). Conclusions: Our findings suggest that Lp(a) levels above 30 mg/dL is associated with a higher risk of CVD in hypertensive patients. These results may have implications for the management and treatment of hypertensive patients with elevated Lp(a) levels.