This study evaluated the occurrence of apatinib-induced hypertension and its impact on the prognosis of patients with solid tumors. A retrospective cohort study with prospective follow-up was conducted on 769 patients treated with apatinib from 2014 to 2021 across three hospitals. Patients were categorized into hypertension and non-hypertension groups. The primary outcome was overall survival (OS), with progression-free survival (PFS) as a secondary outcome. Apatinib-induced hypertension occurred in 33.3% of patients and was associated with significantly longer OS (HR 0.40, 95% CI [0.37-0.48], p <
0.0001) and PFS (HR 0.41, 95% CI [0.35-0.49], p <
0.001). Subgroup analysis confirmed these findings in all cancer types, except for PFS in non-small cell lung cancer. Hypertension may serve as a predictive biomarker for improved anti-tumor efficacy.