Heart failure (HF), a major cause of morbidity and mortality worldwide, is prevalent among individuals with H-type hypertension, which is marked by high blood pressure and elevated homocysteine. The Triglyceride-Glucose (TyG) index, a surrogate for insulin resistance, may predict HF in this group, though its specific role requires clarification. This study explores the TyG index's relationship with HF incidence in H-type hypertension patients. A retrospective cohort study was conducted on 1200 H-type hypertension patients at Wuhan Third Hospital from January 2021 to December 2023. The TyG index was determined using fasting triglyceride and glucose levels. We utilized multivariate Cox regression, adjusting for age, sex, BMI, and lifestyle, to analyze the TyG index's impact on HF. Of the 1,200 patients studied, 254 (21.2%) developed HF over a median follow-up of 24 months. Higher TyG index values significantly correlated with increased HF risk, with each unit rise boosting HF incidence by 45%. Patients in the highest TyG tertile had a notably higher HF incidence (HR 1.45, 95% CI 1.29-1.63, p < 0.001). This association was stronger in diabetic patients compared to non-diabetics. The TyG index showed high predictive accuracy (AUC = 0.78) with good sensitivity (70.9%) and specificity (72.3%) at a cut-off of 8.88. Elevated TyG index significantly predicts higher HF risk in H-type hypertension patients, especially among diabetics. Integrating the TyG index into routine evaluations could improve management and outcomes for high-risk individuals, offering an economical early risk stratification tool.