Hypertension is a very common non communicable disease in Nigeria and has been found to be the leading cause of heart failure in our environment. Heart failure is known to be precipitated by several factors which are often avoidable and/or reversible. Identifying these factors and removing them will reduce hospitalization from heart failure. There is no study known to the researcher that has been carried out in the South-East of Nigeria on precipitating factors for hypertensive heart failure. Aims The aim of this study was to identify precipitating factors for hypertensive heart failure and to determine prevalence of these factors at Nnamdi Azikiwe University Teaching Hospital Nnewi. Subjects and Methods This study was a hospital based cross-sectional study. One hundred and fifty (150) patients who were diagnosed with hypertensive heart failure were recruited consecutively over a one year period. A structured questionnaire was used to collect patients’ medical history. Detailed physical examination and laboratory investigations were carried out on the patients. Results There were 86 males and 64 females with a male to female ratio of 1.3:1. The mean age of the subjects was 62.67 ±12.6 years. The age of the respondents ranged from 31 to 80 years. 56.7% (n=85) of the subjects were traders. 47(31.3%) of the subjects had no formal education while 68(45.3%) had only primary education. 17(11.3%) and 18(12.0%) had secondary and tertiary education respectively. Precipitating factors for heart failure were found in 140(93.3%) of the study population. Renal impairment was the most common precipitating factor with a prevalence of 76%. Poor adherence to heart failure medications was found in 56%(n=14) of the 25 respondents who had been previously treated for heart failure. Other precipitating factors found include anaemia, arrhythmias, heavy alcohol consumption, infections, drugs and severe physical exertion with prevalence of 54%(n=81), 25.3%(n=38) 15.3%(n=23), 6%(n=9), 3.3%(n=5), and 2.4%(n=4) respectively. Myocardial infarction was not found as a precipitating factor in the study population. There was no statistically significant association between age, educational status or gender and the factors identified. Conclusions and recommendations This study has shown that precipitating factors are found in most patients in hypertensive heart failure in Nnewi, South East Nigeria. The observed prevalence of precipitating factors in this study and the factors identified were similar to what has been reported from other parts of Nigeria. These factors should be searched for and treated in order to prevent development of heart failure in hypertensive patients or restore patients already in heart failure to a compensated state.