Background <p>Hypertension is one of the most prevalent chronic diseases globally and is closely related to congestive heart failure (CHF). In this study, we explored the correlation between the risk of CHF in individuals with hypertension and the visceral adiposity index (VAI).</p> Method <p>This study used data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2001 to 2018. A weighted logistic regression model was used to assess the relationship between VAI and CHF. To further explore their relationship, propensity score matching (PSM), confounder adjustment methods, restricted cubic spline (RCS) analysis for nonlinearity, and subgroup analyses by sex, age, and race were also performed.</p> Results <p>A total of 3,613 patients were included in the study. Multivariable logistic regression analysis showed that in the fully adjusted model, there was a significant positive correlation between VAI and CHF (OR = 1.15, 95% CI: 1.04, 1.29); this association remained significant after PSM matching (OR = 1.24, 95% CI: 1.06, 1.45); and the association was still significant after excluding patients with CHD, MI, or stroke (OR = 1.15, 95% CI: 1.04, 1.29). RCS results indicated a significant linear relationship between VAI and the risk of CHF (<i>P</i>-overall = 0.018, <i>P</i>-non-linear = 0.964). Subgroup analysis revealed a significant positive correlation between VAI and CHF in males, individuals under 60 years of age, those with educational attainment below high school, patients with diabetes, drinkers, non-smokers, non-CHD patients, those with AP, and non-stroke patients.</p> Conclusions <p>This study demonstrates that VAI is effective for CHF risk assessment in hypertensive patients.</p>