What causes CAD is atherosclerosis and what causes atherosclerosis is, aside from hypertension, smoking, lipidemia and high glucose levels or having actual diabetes. Other factors are obesity and inactivity -- obesity increases the likelihood of developing lipidemia & hypertension and inactivity increases the risk for heart attack. Of course there are risk factors, called fixed risk factors, that we have no control over. These are gender, family history and age. These have nothing to do with hypertension. The lifetime risk of developing CAD is higher in men than in women at all ages. Being female, you may be relatively protected against CAD but you already have two known risk factors but I can't tell from what you've written if you have more. In case you're interested, in women the duration of insulin-dependent diabetes, hypertension, waist-hip ratio, physical activity and depressive symptomatology are all significant independent predictors of CAD. And even if a person had none of these risk factors, no fixed risk factors, no modifiable risk factors, that person could still develop CAD anyway. "Can you develop coronary artery disease without hypertension?" -- Yes.