Introduction. The association between perceived built environmental attributes and hypertension among adults has received little attention in an African context. We investigated the association between the perceived built environment and prevalent hypertension in adult South Africans. Method. A cross-sectional study was conducted using 2008-2009 Prospective Urban Rural Epidemiology data among South African () adults aged 35 years. Perceived built environment was assessed using the neighborhood environment walkability scale questionnaire. Prevalent hypertension was defined as previously diagnosed by a physician, screen-detected hypertension as 140/90 mmHg, and a combination of both as any hypertension. Logistic regressions were applied for analyses. Results. In crude logistic regressions, self-reported hypertension was associated with land use mix-diversity, street connectivity, infrastructure for walking/cycling, aesthetics, traffic, and crime. In adjusted model, land use mix-diversity was significantly associated with self-reported hypertension. In similar multivariable models, the direction and magnitude of the effects were mostly similar to the outcomes of “screen-detected hypertension” which was further predicted by perceived lack of safety from traffic. Conclusion. Perceived built environment attributes were significantly associated with hypertension. This has relevance to population-based approaches to hypertension prevention and control.