Objective To investigate the relationship between body mass index (BMI) and hypertension among the elderly based on physical examination results in Fuzhou City. Methods Physical examination data of the inviduals over 60 years old who took the examination in our hospital from January to December 2016 were collected and retrospectively analyzed for blood pressure level and the incidences of hypertension, overweight or obesity. Based on BMI stratification, blood pressure levels and incidence of hypertension were evaluated in different BMI-level groups. SPSS statistics 11.7 was adopted for data processing. Unpaired t test or Chi-square test was employed for different data types. Multivariate logistic regression analysis was used to analyze the influencing factors of hypertension, and receiver operating characteristic (ROC) curve was adopted to analyze the correlation of BMI and risk of hypertension. Results In the 1659 enrolled subjects with complete data of physical examination, the incidence of hypertension was 34.2%(568/1659), with that of males accounting for 36.2%(363/1003) and females for 31.2 %(205/656). In the cohort, 48.1%(798/1659) of them were overweight or obese, and the ratio was 48.4%(485/1003) in the males and 47.7%(313/656) in the females. With the increase of BMI, the levels of systolic (SBP) and diastolic blood pressures (DBP) and incidence of hypertension were gradually elevated (for BMI<18.5,8.5-<23.9,4.0-27.9, ≥28.0 kg/m², the incidence of hypertension was 17.0%, 27.4%, 40.4% and 55.5%, respectively). Multivariate logistic regression analysis found that overweight or obesity, high fasting blood glucose, high uric acid and hypertriglyceridemia were risk factors for hypertension. ROC curves analysis related to hypertension risk showed that the area under ROC curve (AUC) of male BMI was 0.601 (cut-off point=25.55 kg/m²) and that of female BMI was 0.609 (cut-off point=25.85 kg/m²) in the risk of systolic hypertension; for the risk of diastolic hypertension, the AUC was 0.665 for the male BMI (cut-off point=25.55 kg/m²) and 0.609 for female BMI (cut-off point=26.35 kg/m²). Conclusion The SBP and DBP levels and hypertension incidence are gradually increased with the increase of BMI level. Overweight or obesity, high fasting blood glucose, high uric acid and hypertriglyceridemia are risk factors for hypertension. BMI shows predictive value of hypertension risk.