Objective  To explore associations of family hypertension history and behavioral risk factor aggregation with hypertension incidence among adult residents for providing evidences to the development of effective strategies on prevention and treatment of hypertension.

  Methods  Using stratified random cluster sampling and the uniform questionnaire for national program on chronic disease prevention and control, we conducted face-to-face interviews and physical examinations among 12 092 permanent residents aged 18 years and above in an urban district of Nantong city, Jiangsu province during October – November 2018. Multivariate logistic regression model was adopted in analysis on the effect of family hypertension history and clustered behavioral risk factors on hypertension incidence.

  Results  Among the 12 064 residents with complete information, totally 4 042 hypertensives were identified, with the crude and standardized prevalence rate of 33.5% and 27.0%, respectively. After adjusting for confounding factors such as gender, age, education, marital status, occupation and body mass index, multivariate logistic regression analyses showed that the residents exposed to following factors had an increased risk of hypertension: family history of hypertension (odds ratio OR = 2.05, 95% confidence interval 95% CI: 1.77 – 2.38), alcohol-drinking (OR = 2.04, 95% CI: 1.32 – 3.17), and consuming high salt diet (OR = 1.92, 95% CI: 1.19 – 3.07) compared to those without the exposures; the analyses also revealed that the residents with family history of hypertension and one or more behavioral risk factors were at a much higher risk of hypertension, with the ORs of 3.38 (95% CI: 2.35 – 4.85) for those with family hypertension history and consuming high salt diet, 5.42 (95% CI: 2.73 – 10.74) for those with the history and smoking plus consuming high salt diet, and 5.84 (95% CI: 2.74 – 12.43) for those with the history and smoking plus alcohol drinking and consuming high salt diet, respectively.

  Conclusion  Family history of hypertension and aggregation of behavioral risk factors can increase the risk of hypertension among adult community residents.