Background <p>This study aims to investigate the relationship between body mass index (BMI) and new-onset hyperuricemia in a Chinese repeat health checkup population. Risk factors associated with hyperuricemia can be better understood and appropriate measures can be proposed, which is important for the prevention of hyperuricemia.</p> Methods <p>53,350 subjects without initial hyperuricemia were recruited from Wuhu between 2011 and 2016. Information collected included demographic characteristics, physical examination, and laboratory testing. Generalized linear regression, Cox regression, and Kaplan-Meier survival curves were used to analyze the relationship between BMI and new-onset hyperuricemia.</p> Results <p>The differences in blood biochemistry and blood routine values between the hypertensive and normotensive groups were statistically significant. In the interaction analysis, there was a significant multiplicative interaction between BMI and hypertension in the risk of hyperuricemia (χ² = 18.622, <i>P</i> &lt; 0.0001). The generalized linear regression models showed a significant positive correlation between BMI and hyperuricemia in both groups after adjusting for confounders. We grouped study participants according to BMI &lt; 30 and BMI ≥ 30. The results showed that the risk of hyperuricemia was significantly higher in the fourth quartile of BMI in both the hypertensive and normotensive groups after correcting for confounders (HR = 1.402, 95%CI = 1.201–1.637, <i>P</i> &lt; 0.0001; HR = 1.341, 95%CI = 1.149–1.565, <i>P</i> &lt; 0.0001). The two groups were grouped according to BMI &lt; 30 and BMI ≥ 30. After 5 years of observation, the incidence of hyperuricemia in the hypertensive group was 61% and 73%, respectively, and in the normotensive group was 47% and 58%, respectively.</p> Conclusions <p>There is a significant interaction between body mass index and hypertension in the risk of developing hyperuricemia. High levels of BMI and hypertension are more likely to lead to hyperuricemia.</p>