Abstract: Objective To understand the association of different obesity types and family hypertension history on the prevalence of hypertension among adult residents in Xicheng District of Beijing City, identify high-risk populations for hypertension, and develop precise prevention strategies, providing a reference for early intervention of hypertension in similar regions in China. Methods Based on the adult chronic disease and its influencing factors surveillance in 2023, questionnaire surveys, physical measurements, and health indicator collection were conducted among 6 221 permanent residents aged 18-79 in Xicheng District. Multivariate logistic regression,the multiplicative and additive models were used to analyze the association of obesity and family hypertension history with the prevalence of hypertension . Results Among the permanent residents in Xicheng District, the prevalence of hypertension was 29.73% (1 850/6 221), with 50.07% (3 115/6 221) having a family hypertension history. The proportions of general obesity, abdominal obesity, and combined obesity were 26.49% (1 648/6 221), 2.93% (182/6 221), and 35.46% (2 206/6 221), respectively. Among different obesity types, compared with people with normal weight, the risk of hypertension was significantly higher in those with combined obesity (OR=4.268, 95% CI: 3.368-5.407). When the family history grade increased from 1 to 2 or 3, the risk of hypertension increased from 1.905 times to 3.702 times or 12.110 times, respectively. The risk of hypertension significantly increased when there was a combination of hypertension family history and obesity aggregation. The top three combinations of hypertension risk factors were 3-generation family history and combined obesity aggregation (OR=40.379, 95% CI: 13.509-120.694), 2-generation family history and combined obesity aggregation (OR=12.978, 95% CI: 9.557-17.624), and 3-generation family history and general obesity aggregation (OR=11.719, 95% CI: 3.481-39.458). Conclusion Both family hypertension history and obesity were independent risk factors for the prevalence of hypertension. The combination of the two could significantly increase the risk of developing hypertension. Therefore, key interventions should be implemented for individuals with a family hypertension history and obesity to delay and prevent the occurrence of hypertension.