The predictive value of apolipoprotein B (apo B) has been proven in the development of coronary artery disease (CAD) among normotensives only, but it has not been directly studied in hypertensive patients. The objective of this study is to explore the association between apo B and CAD among patients with hypertension. Search strategies were conducted on September 24, 2022, and involved the databases PubMed, Web of Science, and Scopus. The current systematic review included observational case-control and cohort study design involving adult humans, both hypertensives and normotensives. The selected studies were restricted to those written in the English language and published after 2000. Reviews, interventional, animal, and overlapping studies, grey literature, and articles without full text were excluded from the current study. The modified Newcastle-Ottawa Scale was used to assess the risk of bias for the screened studies after data extraction. Out of 3644 publications, only five studies were included in the review, including 5222 participants. Of those, 2335 were hypertensive, 733 of them developed CAD, and 296 normotensive subjects developed CAD. The average apo B was 1.09 g/l and 1.07 g/l for hypertensives and normotensives, respectively. The risk of developing CAD is higher in patients with hypertension, or those with higher apo B. Moreover, the risk of CAD was exacerbated in hypertensive participants with elevated apo B. This systematic review highlights the independent power of apo B on the development of CAD among both hypertensive and normotensive subjects.