<p>This study aimed to assess the doctor–patient communication among hypertensive patients in the context of community health service and chronicity of the disease, and to highlight which demographic and clinical factors may make this task less effective for the doctor. The study was conducted at two community hospitals in Changsha, China, from January 1 to November 1, 2024. Set Elicit Give Understand End (SEGUE) framework and a self-developed questionnaire were used to assess doctor–patient communication and hypertension-related content. Multivariable logistic regression was employed to analyze associated factors. We collected 546 valid questionnaires, primarily from elderly individuals with over 10&#xa0;years of hypertension history. The average SEGUE score was 68.80 ± 16.17, with 70.7% of patients having suboptimal communication (SEGUE score &lt; 80). Hypertension-related communication content between doctors and patients was considered insufficient. Only 65.6% of patients reported that doctors discussed the importance of medication for blood pressure control, and 22.0% reported that they were explained the potential side effects of their medication. Factors associated with worse doctor–patient communication included obesity (BMI &gt; 28&#xa0;kg/m²; OR = 0.32, 95% CI 0.17–0.60) and a longer duration of hypertension (&lt; 10&#xa0;years; OR = 0.58, 95% CI 0.34–0.97). Conversely, better communication was also associated with a high school or higher education level (OR = 2.38, 95% CI 1.17–4.86), higher monthly income (2000–4000 yuan: OR = 2.11, 95% CI 1.18–3.77; &gt; 4000 yuan: OR = 2.42, 95% CI 1.21–4.87), and better cognitive function (higher MMSE score; OR = 1.74, 95% CI 1.53–1.99). Most of the hypertensive patients perceived suboptimal doctor–patient communication. Factors associated with this included BMI, hypertension duration, education level, income, and cognitive function.</p>