Abstract To explore the knowledge, attitudes, and practices (KAP) concerning hypertension diets among hypertensive patients, a cross-sectional survey was conducted across designated institutions in Heilongjiang Province and Jiangsu Province from December 2023 to February 2024. Data on sociodemographic factors and KAP scores were collected via questionnaires. A total of 661 valid responses were obtained, with 33.89% reporting a hypertension duration of 3–10 years. Mean knowledge, attitude, and practice scores were 23.40 ± 4.66, 61.15 ± 8.85, and 20.31 ± 3.37, respectively. Linear regression analysis identified several factors independently associated with practice, including knowledge score, attitude score, urban residence, education level, income, salt consumption, and frequency of consuming vegetables and fruits. Structural equation modeling (SEM) revealed direct and indirect effects of knowledge and attitude on practice. Hypertensive patients demonstrated adequate knowledge, positive attitudes, and proactive practices regarding hypertension diets. Healthcare professionals should focus on reinforcing positive attitudes and knowledge transfer to promote consistent and effective dietary practices for hypertension management.