Vascular diseases such as peripheral arterial disease (PAD) and arterial stiffness (AS) may be mediated by hypertension. Cardiovascular disease (CVD) and death are determined by an abnormal ankle-brachial index (ABI). Researchers analyzed the association between an aberrant ABI, an optimum cardiovascular health (CVH) score, and other health parameters with worse outcomes in urban hypertension patients. They tracked 243 hypertension patients from an urban primary care setting for 2 years. Hospitalizations, deaths, and other clinical indicators were documented, as were indicators of hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC). In urban hypertension individuals, a low proportion of optimal CVH was found. The ABI less than or equal to  0.9 group (n=16) had a worse lipid, metabolic, and renal profile than the ABI more than 1.4 group (n=41) and a higher prevalence of past CVD other than PAD, mortality, and hospitalizations. Unfavorable outcomes (HMOD, HRC, death, or hospitalization) were inversely associated with CVH scores and an ABI less than equal to 0.9. An ABI below 0.9 was linked with diabetes and chronic kidney disease (CKD). Further CVH indicators were not linked with outcomes; they included age, sex, diabetes, CKD, ABI less than or equal to 0.9, and optimum cholesterol. There was a negative correlation between CVH score and ABI less than or equal to 0.9 and worse outcomes in hypertension patients from a metropolitan population, and optimal CVH was uncommonly seen. In this group, better results may be achieved by making greater efforts to encourage CVH that meets ideal standards.