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Background: Hypertension and muscle strength are known to be associated; however, identifying simple clinical indicators of this relationship is challenging. Relative muscle strength (RMS), defined as strength per unit muscle mass, has been proposed as a potential indicator, but its association with hypertension is unclear. This study aimed to estimate the prevalence of hypertension and determine its association with RMS in an adult Indian population attending a tertiary care center in Gujarat. Methods: This hospital-based cross-sectional study included 430 adults aged 18 years and older who were admitted to outpatient medicine clinics between January and October 2023. Grip strength and appendicular lean muscle mass (ALM), estimated using a validated formula, were measured. The RMS was calculated as grip strength/ALM. Hypertension was defined using standard criteria. Logistic regression was used to analyze the association between RMS (analyzed continuously and categorically in tertiles) and hypertension, adjusting for confounders. A pvalue of < 0.05 was considered significant. Results: The prevalence of prehypertension and hypertension was 187 (43%) and 96 (23%), respectively. Compared to participants in the low RMS tertile (0.00–2.45 kg/kg ALM), those in the high tertile (3.79–6.12 kg/kg ALM) had 26% lower odds of hypertension (OR 0.74, 95% CI 0.59–0.89) and 33% lower odds of prehypertension (OR 0.67, 95% CI 0.49–0.91) after adjusting for confounders. The RMS also showed strong negative correlations with systolic and diastolic blood pressure (r = − 0.559 and − 0.418, respectively; p< 0.001). Conclusion: Increased RMS was significantly protective against prehypertension and hypertension. These findings highlight the potential importance of muscle quality, beyond muscle mass, in blood pressure regulation.