Hypertension and heart failure are leading causes of morbidity and mortality worldwide, with disproportionately worse outcomes among culturally diverse and socioeconomically marginalized populations. Cultural determinants-including health beliefs, dietary traditions, language barriers, trust in healthcare systems, family dynamics, and perceptions of chronic illness-significantly influence disease recognition, treatment adherence, and long-term cardiovascular outcomes. This narrative review synthesizes current evidence on how cultural, structural, and social factors shape the management of hypertension and heart failure across diverse groups such as immigrants, racial and ethnic minorities, and individuals experiencing housing instability. Existing literature demonstrates that culturally discordant care, limited health literacy, and structural inequities are associated with poor blood pressure control, delayed diagnosis, reduced medication adherence, and higher rates of hospitalization and mortality, whereas culturally tailored interventions-including community health worker engagement, linguistically concordant education, faith-based partnerships, and culturally adapted dietary counseling-improve self-management behaviors and clinical outcomes. The findings underscore the need to integrate cultural competence and structural awareness into cardiovascular care delivery, clinical training, and health policy, emphasizing that addressing cultural determinants is both an ethical obligation and a clinically necessary strategy for improving long-term outcomes in chronic cardiovascular disease.