Background: Hypotension and bradycardia is the most common complication associated withrnspinal anesthesia and more common in patients with history hypertension. Regular use of antihypertensivernrnmedication can prevent this complication. The occurrence of hypotension underrnspinal anesthesia among controlled hypertension and normotensive patients with age 40 yearsrnand above is still debated. rnObjective: To compare hemodynamic response following spinal anesthesia between controlledrnhypertension and normotensive patients undergoing surgery below the umbilicus at Black lionrnhospital, Addis Ababa, Ethiopia, 2020.rnMethod: hospital- based Prospective cohort study design was conducted. A total of 110 electivernpatients with controlled hypertension (55) and normotensive (55) patients below the umbilicalrnsurgery under spinal anesthesia at black the lion hospital during the study period. The Samplernwas selected using a systematic sampling technique. Continuous data of independent andrndependent variables were analyzed using an independent sample t test for normally distributedrnand Mann-Whitney U test for non-normally distributed between the study groups. Categoricalrnvariables between the study groups were analyzed using the chi-square test. Descriptive datarnwere displayed using tables and figures. For continuous and categorical variables a P- value rn0.05. There was a statistical significant difference in the mean systolic blood pressure, meanrnarterial pressure, mean heart rate and vasopressor consumption at the measurement time intervalrnbetween controlled hypertension and normotensive groups. rnConclusion: Under spinal anesthesia patients with controlled hypertension are more likely torndevelop hypotension than normotensive patients but on the occurrence of bradycardia there wasrnno statistical significant difference between the two groups. Vasopressor consumption is higherrnin controlled hypertension than the normotensive group.