<p>This cross-sectional study aimed to explore the interactions of overweight, obesity, central obesity, and dyslipidemia with the prevalence and control of hypertension among adults. Data were derived from the 2023 China Chronic Disease and Risk Factor Surveillance (CCDRFS) survey, which provided province-wide representative data from 8 national surveillance points in Gansu Province, encompassing 4997 residents aged ≥ 18&#xa0;years. All participants underwent questionnaire interviews, anthropometric measurements, and biological sample collection. The overall standardized prevalence of hypertension was 34.1%, and the standardized control rate among hypertensive subjects was 12.8%. Prevalence rate was higher in males and rural residents compared with females and urban residents, whereas the control rate was higher among females and rural residents. Participants with overweight, obesity, central obesity, waist-to-height ratio (WHtR) ≥ P₇₅ (i.e., the highest quartile, Q4), or dyslipidemia exhibited higher prevalence and lower control of hypertension. Elevated BMI, waist circumference (WC), and WHtR, and dyslipidemia were each independently associated with higher hypertension prevalence and poorer hypertension control. Among these indicators, WHtR showed the strongest association with hypertension prevalence. Regarding additive interactions, negative additive interactions were specifically observed for overweight with dyslipidemia on hypertension prevalence, and for central obesity with dyslipidemia on hypertension control, suggesting that the combined effects did not produce synergistic worsening. Although causal inferences cannot be drawn due to the cross-sectional design, these findings support the integration of weight and lipid management into comprehensive hypertension prevention strategies.</p>