Background: Hyperuricemia (HUA) is a significant public health issue closely associated with obesity. The novel visceral adiposity index (METS-VF) demonstrates predictive value for multiple chronic diseases, yet its association with HUA risk in hypertensive patients remains unclear. This study aimed to investigate this association in a Chinese hypertensive population. Methods:This study utilized data from the Chinese Hypertension Registry Study, including 13,341 hypertensive patients. Data collection was conducted through standardized questionnaires, physical examinations, and laboratory tests. The association between METS-VF and hyperuricemia (HUA) was evaluated using multivariate logistic regression. Robustness was assessed via multivariable-adjusted models and subgroup analyzes. Results:The prevalence of HUA was 44.32%. Each unit increase in METS-VF was associated with a 13.87 (95% CI: 12.29, 15.45) μmol/L increase in serum uric acid levels and a 30% higher risk of HUA (OR = 1.30; 95% CI: 1.25, 1.36). The risk of HUA rose significantly across increasing METS-VF quartiles (P for trend < 0.001). Subgroup analysis indicated a stronger association in women (P for interaction < 0.001). Conclusion: In patients with hypertension, the visceral adiposity index (METS-VF) was positively associated with the risk of hyperuricemia (HUA).