Hypertension is one of the common medical conditions observed among patients aged 50 years and elder living with HIV (EPLWH) and to date no systematic review has estimated its global prevalence. To conduct a systematic review to estimate the global prevalence of hypertension among EPLWH. PubMed/MEDLINE, Embase, the Cochrane Library, and Global Health databases for relevant publications up till May 25, 2018. Observational studies (cohort or cross-sectional studies) that estimated the prevalence of hypertension among EPLWH. Required data were extracted independently by three reviewers and the main outcome was hypertension prevalence among EPLWH. The 24 (n = 29,987) eligible studies included were conducted in North America, Europe, Africa, and Asia. A low level bias threat to the estimated hypertension prevalence rates was observed. The global prevalence of hypertension among EPLWH was estimated at 42.0% (95% CI 29.6%-55.4%), I = 100%. The subgroup analysis showed that North America has the highest prevalence of hypertension 50.2% (95% CI 29.2% -71.2%) followed by Europe 37.8% (95% CI 30.7%-45.7%) sub-Saharan Africa 31.9% (95% CI 18.5% -49.2%) and Asia 31.0% (95% CI 26.1%-36.3%). We found the mean age of the participants explaining a considerable part of variation in hypertension prevalence. This study demonstrated that two out of five EPLWH are hypertensive. North America appears to have the highest prevalence of hypertension followed by Europe, sub-Saharan Africa (SSA) and Asia respectively. Findings from this study can be utilized to integrate hypertension management to HIV management package. (Registration number: CRD42018103069).