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Hypertension is one of the most common leading causes of global public health emergencies and a major contributor to cardiovascular complications such as stroke and myocardial infarction, all of which adversely affect the quality of life (QOL) of people living with hypertension. Despite this burden, there remains a limited understanding of the various factors affecting the quality of life of people living with hypertension, particularly in low-and-middle income settings. This study aims to assess the quality of life among people living with hypertension along with the various factors associated with it, in the Kathmandu District, Nepal. A cross-sectional study was carried out in a selected hospital of Kathmandu District from February to March 2023, with a total sample size of 200 people living with hypertension. Data were collected using a semi-structured interview, and WHOQOL-BREF was used to measure the outcome variable. Descriptive statistics were used to summarize the socio-demographic, social, psychological, and behavioral factors. Bivariate analysis was performed using the chi-square test, and variables with a p-value < 0.2 were entered into the multivariable logistic regression model. In the final model, variables with p-values < 0.05 were considered statistically significant. All statistical analyses were conducted using Statistical Package for Social Sciences version 20. A total of 200 people living with hypertension participated, aged 30–80 years (mean ± SD: 51.4 ± 13.1), with slightly more males (53.5%). Most of the people were Hindu (74.0%) and from upper caste groups (46.5%), and 37% had a monthly income of < NPR 25,000, and 88% had a good quality of life. Lower income (p = 0.027) and illiteracy (p = 0.049), lack of family support (p = 0.001), non-consumption of meat and fish (p = 0.005), higher salt intake (p = 0.045), physical inactivity (p < 0.001), and irregular medication use (p = 0.001) were associated with poor QOL. In multivariable analysis, family support (aOR = 0.30, 95% CI: 0.10–0.87), meat and fish consumption (aOR = 0.22, 95% CI: 0.07–0.75), and physical activity (aOR = 0.08, 95% CI: 0.01–0.70) were significantly protective against poor QOL. Poor quality of life among people living with hypertension was primarily associated with both modifiable behavioral and social factors, and socio-demographic characteristics. Interventions that strengthen social support, promote healthy dietary practices, and encourage regular physical activity may substantially improve the quality of life among individuals living with hypertension.