Prevalence and associated factors of obesity-related hypertension among Malaysian adults: findings from the National Health and Morbidity Survey 2023

Obesity-related hypertension contributes significantly to cardiovascular risk and poses a major public health concern. This study aimed to determine the prevalence of obesity-related hypertension and its associated factors among Malaysian adults. Data were derived from a nationwide health survey of adults aged ≥ 18 years ( n = 10,071) conducted in 2023. Obesity-related hypertension was defined as the concurrent presence of general obesity, abdominal obesity, and hypertension (BMI ≥ 27.5 kg/m² with waist circumference ≥ 90 cm for men and ≥ 80 cm for women, and systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or a prior physician diagnosis). Multinomial logistic regression accounting for the complex sampling design was used to identify associated sociodemographic, behavioural, and clinical factors. The overall weighted prevalence of obesity-related hypertension among Malaysian adults was 10.0% (95% CI: 9.13, 10.86), while 10.8% (95% CI: 9.93, 11.80) presented with obesity only and 20.0% (95% CI: 18.78, 21.33) with hypertension only. Multinomial logistic regression analysis demonstrated that females (aOR: 1.53; 95% CI: 1.25, 1.86), adults aged 60 years and above (aOR: 2.80; 95% CI: 2.07, 3.77), and individuals with lower educational attainment (aOR: 1.71; 95% CI: 1.17, 2.49) had significantly higher odds of obesity-related hypertension compared with the normal reference group. Additionally, modifiable factors were independently associated with the condition, including physical inactivity (aOR: 1.26; 95% CI: 1.03, 1.55), diabetes mellitus (aOR: 4.49; 95% CI: 3.53, 5.72), and hypercholesterolemia (aOR: 2.30; 95% CI: 1.88, 2.81). Obesity-related hypertension affects approximately one in ten Malaysian adults and represents a distinct and significant cardiometabolic burden. The condition is strongly associated with demographic, behavioural, and metabolic factors. These findings highlight the need for integrated, targeted prevention strategies within primary care and national non-communicable disease frameworks to address this growing public health challenge.