Background <p>Hypertension self-management is essential for reducing complications and maintaining functional well-being in later life, yet the multi-level factors associated with self-management among older adults remain insufficiently understood. This study investigated pathways linking predisposing, enabling, and reinforcing factors to hypertension self-management behaviors (HSMB) among older adults using a PRECEDE–PROCEED theory-guided model.</p> Methods <p>A cross-sectional study was conducted from late March to early April 2026 among 264 older adults with hypertension in Chongqing, China. Data were collected through interviewer-administered structured questionnaires. Pearson correlation analysis and path analysis were used to examine direct and indirect associations among hypertension-related knowledge, self-efficacy, health education, healthcare resources and access, family support, and HSMB.</p> Results <p>Self-efficacy and hypertension-related knowledge showed significant direct associations with HSMB. Healthcare resources and access demonstrated both direct and indirect associations with HSMB through knowledge and self-efficacy. Family support was associated with HSMB both directly and indirectly through healthcare resources and access, knowledge, and self-efficacy. Health education showed a negative indirect association with HSMB through knowledge, suggesting that the content, timing, or targeting of education may warrant closer examination.</p> Conclusions <p>HSMB among older adults was associated with multi-level cognitive, environmental, and social factors. Self-efficacy, healthcare resources and access, and family support appeared to be particularly important correlates. Interventions for older adults with hypertension may benefit from combining skills-building, accessible services, and family-engaged support while improving the relevance and comprehensibility of health education.</p>