Hypertension affects about 1.28 billion adults worldwide and is the leading modifiable risk factor for cardiovascular disease and stroke. Using county-level data from 2,987 U.S. counties, this study developed Random Forest models that predicted hypertension prevalence with high accuracy (R² up to 0.972), while a model using only seven environmental and geographic variables still explained 94.5% of the spatial variation. Latitude emerged as the strongest predictor, and geospatial analysis identified rural Southeastern counties with higher-than-expected hypertension rates, highlighting areas where unobserved social and structural factors may contribute to risk.