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Background: Early assessment of renal changes is important in the evaluation and monitoring of hypertensive patients, and ultrasonography is a safe, non-invasive and widely available method for measuring kidney size. Objective: To assess kidney size using ultrasonography among hypertensive patients in Owerri, Imo State, Nigeria, and to examine its relationship with age, sex, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods: This prospective cross-sectional study recruited 100 hypertensive patients attending the ultrasound units of the Federal Teaching Hospital, Owerri, and Everight Diagnostics and Laboratory Services, Owerri. Blood pressure was measured with an automatic digital monitor, and the length and width of both kidneys were measured with a 3-5 MHz curvilinear transducer. Data were analyzed using descriptive statistics, Pearson correlation and independent-samples t-test, with significance set at p < 0.05. Results: The mean right kidney length and width were 92.70 +/- 7.57 mm and 41.73 +/- 4.33 mm, respectively, while the mean left kidney length and width were 96.57 +/- 8.81 mm and 46.10 +/- 5.00 mm. The left kidney was consistently larger than the right, although both mean kidney lengths were slightly below the reported normal adult range. There was no significant correlation between age and renal dimensions (p > 0.05) and no significant difference between male and female participants (p > 0.05). SBP showed weak positive correlations with left kidney length (r = 0.20, p = 0.044) and left kidney width (r = 0.20, p = 0.045), and DBP with left kidney width (r = 0.22, p = 0.026). No significant correlations were found between blood pressure and right kidney dimensions. Conclusion: Weak positive correlations between blood pressure and left renal dimensions suggest a possible relationship that may be consistent with compensatory renal changes, but blood pressure alone appears to be a poor predictor of kidney size. The left kidney was slightly larger than the right, and mean kidney lengths were slightly below the reported normal adult range, suggesting possible renal changes in hypertensive patients.