Associations of Obesity and Hypertension with Health-Related Physical Fitness among Women Living in Tibet: A Cross-Sectional Study

Objectives: To investigate the relationship between hypertension, obesity, and physical health in women at high altitude, and to identify modifiable associated factors. Methods: This cross-sectional study included 1736 women residing in Tibet aged 20–69 years from three altitudinal regions. Anthropometry, blood pressure, and health-related physical fitness (body composition, cardiorespiratory endurance, muscle strength, muscle endurance, flexibility) were measured. Group differences were examined using chi-square tests and one-way ANOVA, and binary logistic regression was used to identify factors associated with hypertension, obesity, and HPF qualification status. Results: Hypertension and obesity were highly prevalent. Regular exercise and higher education were independently associated with lower odds of both obesity and hypertension. Hypertension alone was not associated with an increased risk of physical unfitness; however, its co-presence with obesity was associated with a markedly elevated risk of unfitness. Conclusions: Hypertension alone was not significantly associated with unqualified HPF status, whereas the co-presence of hypertension and excess waist circumference was associated with poorer HPF outcomes. Different hypertension subtypes showed distinct patterns of association with selected HPF indicators. Regular exercise and higher education were associated with lower odds of obesity, hypertension, or unqualified HPF status. Integrated strategies targeting both adiposity and blood pressure are essential for metabolic health in high-altitude populations.