The Dynamic Interplay of Lifestyle, Dietary Factors, and Cardiometabolic Risk in Hypertension: A Cross-Sectional Investigation Among Saudi Adults

<b>Background/Objectives</b>: Hypertension is a growing public health concern in Saudi Arabia, driven by rapid socioeconomic changes. This study investigated the interplay between habitual, behavioral, and dietary risk factors associated with hypertension among Saudi adults. <b>Methods</b>: A cross-sectional survey was conducted among 3312 Saudi adults using multistage stratified random sampling. The data were collected via validated questionnaires assessing sociodemographic, anthropometric indicators, lifestyle behaviors, dietary patterns, and medical history. Hypertension status was determined through self-reported diagnosis. Bivariate analyses and multiple logistic regression identified independent predictors (<i>p</i> < 0.05). <b>Results</b>: Hypertension prevalence was 13% (mean age: 34 ± 15 years; 50% male). The strongest predictors were age (OR = 1.08/year; 95% CI: 1.07-1.10; <i>p</i> < 0.001), increased body mass index (OR = 1.03; 95% CI: 1.01-1.06; <i>p</i> = 0.011), smoking (OR = 1.55; 95% CI: 1.04-2.29; <i>p</i> = 0.030), and family history of hypertension (OR = 7.71; 95% CI: 5.61-10.75; <i>p</i> < 0.001). Participants with diabetes mellitus had 89% higher odds of hypertension (OR = 1.89; 95% CI: 1.42-2.51; <i>p</i> < 0.001), and those with dyslipidemia had more than double the odds (OR = 2.45; 95% CI: 1.38-4.22; <i>p</i> = 0.002). Protective factors included higher income (≥15,000 SAR; OR = 0.54; 95% CI: 0.36-0.81; <i>p</i> = 0.003) and regular whole grain consumption (OR = 0.60; 95% CI: 0.46-0.77; <i>p</i> < 0.001). <b>Conclusions</b>: Hypertension risk in Saudi adults is shaped by age, obesity, smoking, comorbid metabolic conditions (diabetes and dyslipidemia), and genetic pre-disposition. In contrast, higher income and whole grain intake may offer protection. These findings underscore the need for comprehensive prevention strategies that address both lifestyle and cardiometabolic comorbidities, in alignment with Saudi Vision 2030 health priorities.