Background <p>This study aimed to assess the knowledge, attitudes, and practices (KAP) related to hypertensive nephropathy among patients diagnosed with hypertension in the Xinjiang of China.</p> Methods <p>A cross-sectional survey was conducted between April 1 and April 30, 2024, in Xinjiang, China. Data were collected using a structured questionnaire designed to capture demographic characteristics and evaluate patients' KAP toward hypertensive nephropathy. Participants were individuals with a confirmed diagnosis of hypertension.</p> Results <p>A total of 687 hypertensive patients were included in the final analysis, yielding a response rate of 98%. Among them, 58% were male. The majority of respondents (43%) had been diagnosed with hypertension for three years or less. Their median [q25, q75] knowledge, attitude, and practice scores were 6 (2,10) (possible range: 0–32), 24 (23,26) (possible range: 6–30), and 25 (18,31) (possible range: 9–45), respectively. The structural equation modeling (SEM) showed that knowledge had direct effects on attitude (β = 0.42, <i>P</i> &lt; 0.001) and practice (β = 2.87, <i>P</i> &lt; 0.001). Meanwhile, attitude had a direct effect on practice (β = -0.31, <i>P</i> &lt; 0.001). Furthermore, knowledge indirectly affected practice through attitude (β = -0.13, <i>P</i> = 0.005).</p> Conclusion <p>Patients diagnosed with hypertension in Xinjiang exhibited limited knowledge, generally positive attitudes, but suboptimal health practices regarding hypertensive nephropathy. To improve clinical outcomes, educational interventions targeting hypertension-related renal complications should be prioritized, with a focus on enhancing patient knowledge as a means to foster more effective self-care behaviors.</p>