Objective The characteristics of bladder calculi and their correlation with hypertension in Southern Hunan, China were analyzed retrospectively to guide the prevention and treatment of bladder calculi and hypertension. Materials and methods A retrospective cohort study of medical records was conducted in the First Affiliated Hospital of University of South China from December 2017 to December 2021. The subjects were patients over 14 years old who were diagnosed with bladder calculi by imaging examination and whose calculi were removed. Analysis was conducted on the patients’ basic characteristics and calculus composition, characteristics, and relationship with hypertension. Results A total of 352 cases of bladder calculi were enrolled. The age ranged from 15 years to 89 years with an average of (65.56 ± 11.94) years. Most of the respondents came from rural areas (61.4%). Calcium oxalate was the main component of the stones. Calcium oxalate and carbonate apatite were the most common mixed stones, and pure uric acid was the most common single stone. The pure uric acid stones were significantly larger than the pure calcium oxalate stones (P < 0.05). In addition, 26.1% of the patients with bladder calculi experienced hypertension. Binary logistic regression showed that hypertension was an independent risk factor for bladder calculi (B = 2.584, OR = 1.685, P < 0.05). Conclusion The management of bladder calculi in Southern Hunan can be guided by local demographic data. Hypertension may be one of the independent risk factors for bladder calculi.