Multidimensional risk factors for hypertension among Moroccan women: a case–control study integrating lifestyle, reproductive, anthropometric, biological, and quality-of-life indicators

The burden of hypertension is increasing in countries undergoing rapid nutritional, lifestyle, and epidemiological transitions, creating an urgent need for context-specific prevention strategies. Among Moroccan women, hypertension may reflect the combined influence of lifestyle behaviors, reproductive history, adiposity, biological alterations, cardiometabolic risk, and health-related quality of life (HRQoL). However, these dimensions are rarely examined together in a single integrated framework. This case–control study included 430 Moroccan women, comprising 215 hypertensive cases and 215 normotensive controls. Sociodemographic, reproductive, clinical, lifestyle, dietary, anthropometric, body composition, biological, and quality-of-life data were collected. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), Mediterranean diet adherence using the Mediterranean Diet Adherence Screener (MEDAS), and health-related quality of life using the 12-item Short Form Health Survey (SF-12). Biological markers included fasting blood glucose, glycated hemoglobin (HbA1c), total cholesterol, uric acid, creatinine, and hemoglobin. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with hypertension. Participants with hypertension showed a less favorable multidimensional profile than normotensive controls. In the adjusted model, elevated waist-to-height ratio showed the strongest association with hypertension (AOR = 2.83; 95% CI: 1.61–4.98), followed by family history of hypertension (AOR = 2.47; 95% CI: 1.49–4.09), elevated visceral fat level (AOR = 2.40; 95% CI: 1.38–4.18), low physical activity (AOR = 2.22; 95% CI: 1.31–3.76), low SF-12 physical component score (AOR = 2.18; 95% CI: 1.29–3.68), low Mediterranean diet adherence (AOR = 2.08; 95% CI: 1.20–3.59), and hyperuricemia (AOR = 2.01; 95% CI: 1.15–3.50). Routine primary healthcare assessment should extend beyond blood pressure measurement to include central adiposity, physical inactivity, sedentary behavior, dietary patterns, reproductive history, cardiometabolic comorbidities, and HRQoL. This integrated approach may support the identification of high-risk women and guide more personalized prevention and management of hypertension.