BACKGROUND: Illness representation is an implicit belief system about an illness constructed by an individual to give meaning to their illness. An individual’s belief about his/her illness, treatment, and own control are known to influence an individual’s ability to cope with the illness and sustain the health-related quality of life. However, how Ethiopians perceive hypertension has not been studied well. This study aimed to assess illness representation and associated factors among hypertensive patients in Central Ethiopia.METHOD: A facility-based cross-sectional study was conducted in four public hospitals in Central Ethiopia. A total of 989 patients participated in the study. The revised Illness Representation Questionnaire was used to collect relevant data. Data were analyzed using the Generalized Estimating Equation with an ordinal logistic regression model and exchangeable working correlation matrix. A P-Value of less than 0.05 was indicated statistical significance.RESULTS: Overall, 64.3% (95% CI: 61.3, 67.4) of the respondents reported low to moderate Illness representation about their  hypertension. Respondents who were housewife [AOR: 1.48, 95% CI= 1.05, 2.08], in older age category 50-64 years [AOR: 1.92, 95% CI= 1.19, 3.09] and ≥ 65 years [AOR: 2.38, 95% CI= 1.43, 3.96], and had no family support [AOR: 1.98, 95% CI= 1.44, 2.73] showed a significant association with Illness Representation.CONCLUSION: This study revealed that about two-thirds of hypertensive patients in Central Ethiopia perceived hypertension as a low to moderately threatening illness. Such low illness representation undermines initiation of treatment and effective control of blood pressure. Health care providers need to strengthen strategies that increase their patient’s illness representation.KEYWORDS: Illness representation, illness perception, hypertension, Ethiopia