Background: Hypertension is a leading modifiable risk factor for cardiovascular disease. Local hospital-level data on prevalence, awareness, treatment, and control are essential to guide screening and management programs. Objectives: To estimate the prevalence of hypertension, document awareness, treatment, and control rates, and describe the major complications associated with hypertension among adult outpatients attending a tertiary care centre in Gonda, Uttar Pradesh. Methods: Cross-sectional screening of adult outpatients (≥18 years) visiting outpatient departments between September 2024 and August 2025. A total of 44,367 consecutive consenting participants had blood pressure measured following standard protocol. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or self-reported antihypertensive use. Data on awareness, treatment, control, and complications were analyzed using descriptive statistics. Results: Overall hypertension prevalence: 28.5% (95% CI 27.9–29.1). Among hypertensives, awareness was 52.3%, treatment 45.7%, and control 19.8%. Complications were observed in 22.5% of hypertensive patients. The most frequent complications were hypertensive heart disease (8.9%), stroke/TIA (5.1%), chronic kidney disease (4.3%), and retinopathy (3.2%). Conclusions: Screening of 44,367 outpatients revealed a high prevalence of hypertension with low control rates and considerable target organ damage. Early detection and management are essential to reduce morbidity and mortality.