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Background: Hearing loss and hypertension are leading causes of disability, affecting over 360 million people. The aim of this study was to assess the impacts of factors such as vitamin D and sleep disorder on the risk of hearing loss among hypertensive patients. Material and methods: This prospective cohort study involved 885 patients aged between 25 and 65 years old who visited our ENT and Endocrinology departments. The study was based on biochemical tests, physical examination, hearing assessment, and Pittsburgh Sleep Quality Index test. Statistical analysis used bivariate and multivariate stepwise regression. Results: Of 855 hypertensive patients, 184 (21.5%) had hearing loss. There were statistically significant differences between hypertensive patients with and without hearing loss in terms of BMI, smoking, family history of diabetes, tinnitus, vertigo, and headache. Moreover, there were statistically significant differences between hypertensive patients with hearing loss versus those with normal hearing in terms of vitamin D, calcium, magnesium, potassium, fasting glucose, HbA1C, HDL, systolic and diastolic blood pressure, microalbuminuria, and sleep quality. Among hypertensive patients, a multivariate regression analysis (stepwise method) indicated that vertigo, systolic blood pressure, vitamin D deficiency, numbness in the hand, tinnitus, vigorous activity, metabolic syndrome, sleep disturbance, and obesity were all risk predictors of hearing loss. Conclusions: Controlling hypertension, vitamin D level, sleep, and lifestyle might lower the risk of hearing loss among hypertensive patients. [ABSTRACT FROM AUTHOR]