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Introduction: It is estimated that hypertension (HTN) increases the risk at least twofold for cardiovascular diseases including coronary artery diseases, congestive heart failure/stroke (ischemic and hemorrhagic), renal failure, and peripheral arterial disease. In wide consensus, HTN is considered Vyanabala Vaishamya by recent Ayurvedic scholars. The aim of the study was to evaluate the effect of an Ayurvedic formulation and Nidana Parivarjana in the management of Vyanabala Vaishamya with special reference to Stage 1 primary HTN as per 8th JNC criteria. Methods: The present study was a randomized, interventional, two-arm, open-level, 30-day clinical trial on Vyanabala Vaishamya (primary HTN). Twenty-five patients in Group A were administered Ayurvedic formulation and 25 patients in Group B were administered Ayurvedic formulation along with Nidana Parivarjana (avoidance of causative factors) decided as per Ayurveda principles. Results: Ayurvedic formulation alone lowered systolic blood pressure (BP) mean from 150.087 (standard deviation [SD] ± 6.331) to 142.478 (SD ± 6.842) and diastolic BP mean from 93.609 (SD ± 3.539) to 89.522 (SD ± 3.566), while Ayurvedic formulation with Nidana Parivarjana lowered systolic BP mean from 151.000 (SD ± 5.800) to 136.174 (SD ± 5.449) and diastolic BP mean from 93.652 (SD ± 3.406) to 85.435 (SD ± 3.678). Although the reductions in BPs of both the groups were statistically highly significantly (P < 0.001), Ayurvedic formulation with Nidana Parivarjana was more effective in lowering the BPs than Ayurvedic formulation alone as found on intergroup comparison (P < 0.001). Conclusion: Ayurvedic formulation with Nidana Parivarjana was more effective in primary HTN than Ayurvedic formulation alone. It also proved that Nidana Parivarjana has a significant role in the management of Vyanabala Vaishamya, i.e., primary HTN.