Background: Globally, non communicable diseases (NCDS) are the leading causes of morbidity, hospital admission and death, those diseases kill 38 million people each year, of which almost three 28 million of NCD deaths occur in low and middle income countries and sixteen million NCD related deaths occur before the age of 70; 82% of these "premature" deaths occurred in low and middle income countries. A number of emergent organ-specific NCDs found in people with HIV which include hypertension also known as Silent Killer. Available data on hypertension among patients on ART are almost exclusively from established HIV cohort data in high-income countries. Objective: To assess the enormity (magnitude) and authoritative definitive factors of silent killer among people living with Retrovirus in Dessie Referral Hospital, North East Ethiopia, 2017. Method: Institutional based cross sectional study was carried out in August 2017. A total of 355 HIV infected individuals on ART were selected using systematic sampling method and data were collected using exit interview and direct blood pressure measurement. Results: Out of 355 HIV infect individual who were on ART, 8.4% [5.5% - 11.3%] had confirmed hypertension. Being urban residence [AOR= 2.1, 95%CI; (1.2-6.98)], having sedentary work activity [AOR= 5.9, 95%CI ;( 2.3-15.3)], overweight [AOR= 2.7, 95%CI, (1.0-7.18)] and taking ART for more than three years [(AOR=3.2; 95%CI (1.5-7.2)] were positively associated with the development of hypertension. Conclusion: Generally this study shows that a significant number of HIV infected individuals were affected by hypertension as co morbidity. So that ART clinicians should screen ART clients for non communicable disease and better counsel them for life style modifications.