Abstract—Obesity increases the risk for diabetes, but there is limited evidence for this relationship among patients with hypertension. A retrospective cohort study was undertaken between 1/10/2013 and 30/9/2017. It included patients with hypertension visiting primary health care centres located in Qatif Province, Saudi Arabia. It included 438 patients (234 obese and 204 non-obese) with normal or prediabetic levels of fasting blood glucose and/or haemoglobin A1c at baseline. The incidence of type 2 diabetes per 1,000 person-years among obese and non-obese groups was 100.7 (95% confidence interval: 79.5-125.9), and 63.8 (95% confidence interval: 46.7-85.1) respectively. Median follow-up duration was 38.3 months. Yearly incidence of diabetes was the highest in the first two years of follow-up among obese and non-obese groups, and thereafter remained high only in the obese group. Predictors of type 2 diabetes development included being female, having a family history of diabetes, having a dyslipidaemia, higher fasting blood glucose level per mg/dl, and higher body mass index per kg/m2. The result showed high incidence rates of diabetes among hypertension patient and was particularly profound among patients who are obese. Primary diabetes prevention program is in need in this country.