Many studies have demonstrated that hyperuricemia is associated with hypertension (HTN) development, but few studies have explored whether urate-lowering therapy (ULT), which reverses hyperuricemia, decreases the risk of incident HTN. In this retrospective cohort study, we compared the risk of incident HTN of gout patients between those undergoing and not undergoing ULT. Risks of new-onset diabetes mellitus (DM) and chronic kidney disease (CKD) were also examined. In total, 2712 gout patients from 2000 to 2012 were enrolled. Overall incidence rates of HTN, DM, and CKD were compared between 1356 patients undergoing ULT recipients and 1356 matched control patients. After adjustment for sex, age, area, comorbidities, and drugs used, the incidence rates of HTN were 4.8 and 3.0 per 100 person years for non-ULT and ULT patients, respectively. ULT patients had a lower adjusted hazard ratio (aHR) of HTN (aHR: 0.64, 95% confidence interval [CI]: 0.54-0.75, p < 0.001) than non-ULT patients. The lower risk of incident HTN after xanthine oxidase inhibitors exhibited a significant dose-response trend. ULT patients also had a lower risk of DM (aHR: 0.55, 95% CI: 0.43-0.70) than non-ULT patients. ULT patients exhibited no significant difference in CKD development (aHR: 1.04, 95% CI: 0.85-1.27) as compared with non-ULT patients. The present study revealed that ULT was associated with lower risks of incident HTN and DM, and the protective effect of xanthine oxidase inhibitors seemed to have a dose-response relationship.