Objectives This study aimed to determine the prevalence of, and understand the factors associated with, hypertension among the Raute nomadic hunter-gatherers of Western Nepal. Design A mixed-method study with quantitative and qualitative analyses. Setting Household survey at Raute temporary camps in the Surkhet District of Karnali Province, Nepal between the period of May to September 2021. Primary and secondary outcome measures The presence of hypertension and its socio-demographic, anthropometric, and behavioral covariates among the participants. Participants For quantitative analysis, all men and non-pregnant women of the nomadic Raute community aged 15 years above were evaluated for hypertension and its covariates. For the qualitative analysis, we purposively selected both Raute and Non-Raute key informants for in-depth interviews to understand, explain and enrich the quantitative findings. Results Of the 85 total eligible participants, 81 [median age 35 years (Interquartile range: 26-51), 46.9% female] were included in the final analysis. The prevalence of hypertension among men, women, and overall was 48.8% (95% confidence interval (CI): 34.4-63.4), 10.5% (95% CI: 3.7-23.1), and 30.9% (95% CI: 21.6-41.5) respectively. Male sex [adjusted Odds Ratio (aOR)=8.05 (95%CI: 2.15-30.11), p=0.002] and increasing age [aOR=1.05 (95% CI: 1.01-1.09), p=0.025] were found significantly associated with hypertension. A large proportion of the participants were current drinkers (91.4%) and tobacco users (70.4%), yet neither of these factors had a significant association with hypertension. Effect of socio-economic transition; changing patterns of alcohol and tobacco use, changing diet and food security; and traditional health care practices were the themes identified in the qualitative analysis. Conclusion This study found a high prevalence of hypertension, alcohol, and tobacco use among Raute nomadic hunter-gatherers facing socio-economic and nutritional transition. Further longitudinal studies and effective culture-centered community-based interventions are urgently needed to reduce the morbidity and mortality associated with hypertension in this endangered indigenous population. Keywords Hunter-gatherers, Foragers, Hypertension, Blood pressure, Socio-economic transition, Raute