Background/Objectives: The aim of this study was to evaluate the association between hypertensive disorders of pregnancy and the frequency of urinary incontinence and lower urinary tract symptoms and to assess the impact of these symptoms on quality of life in pregnant women. Methods: This observational comparative study was conducted between March 2024 and September 2025 and included 182 pregnant women between 24 and 40 weeks of gestation. The study group consisted of 91 pregnant women diagnosed with hypertensive disorders of pregnancy, while 91 normotensive pregnant women served as controls. Demographic and obstetric characteristics were recorded. Urinary incontinence and selected lower urinary tract symptoms, as well as the impact of urinary symptoms on quality of life, were assessed using the International Consultation on Incontinence Questionnaire–Short Form, Urinary Distress Inventory-6, and Incontinence Impact Questionnaire-7. Logistic regression analyses were performed to identify independent factors associated with the presence of urinary incontinence. Results: Urinary incontinence was significantly more frequent in the hypertensive group compared with controls (65.9% vs. 20.9%, p < 0.001). Lower urinary tract symptoms were also more prevalent among hypertensive pregnant women (71.5% vs. 53.8%, p = 0.011). UDI-6, ICIQ-SF, and total IIQ-7 scores were significantly higher in the hypertensive group, indicating greater symptom severity and worse quality of life (all p < 0.001). In multivariable logistic regression analysis including the entire study population, hypertensive pregnancy was independently associated with urinary incontinence (OR: 8.33, 95% CI: 4.00–16.67, p < 0.001), whereas age, body mass index, smoking status, and gravida were not independently associated with UI. Conclusions: Hypertensive disorders of pregnancy are strongly and independently associated with an increased frequency of urinary incontinence and lower urinary tract symptoms, as well as a significant deterioration in quality of life. These findings highlight the importance of routine evaluation of urinary symptoms in hypertensive pregnancies and support a multidisciplinary approach to their management.