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The association between waist circumference (WC) and hypertension, and if this association varies by sex or by body mass index (BMI) categories have not deeply been assessed in the American continent. We aimed to evaluate whether an association between abdominal obesity and hypertension exists and if sex and BMI configure effect modifiers of such association. A secondary analysis of the Peruvian Demographic Family Health Survey data was conducted. Subjects aged from 20 to 69 years were included. Hypertension, defined by the Eighth Joint National Committee, was chosen as the outcome, whereas abdominal obesity (using WC cutoffs based on the 2001 National Cholesterol Education Program Adult Treatment Panel III) was selected as exposure. Poisson regression was used to report prevalence ratios (PR) and 95% confidence intervals (95%CI). Data from 144,156 subjects [mean age 41.4 (SD = 13.4), 54.8% of whom were women] were analyzed. Prevalence of abdominal obesity and hypertension totaled 45.4 and 19.5%, respectively. The adjusted model associated abdominal obesity with greater hypertension prevalence (PR = 1.31; 95%CI: 1.24-1.39). BMI, but nor sex, was an effect modifier of the association. Thus, those obese by BMI and abdominally obese had the strongest association with hypertension (PR = 2.76; 95%CI: 2.58-2.94) than those with normal BMI and no abdominal obesity. Our results evince a positive association between abdominal obesity and hypertension depending on BMI category. Those obese by both BMI and WC had the strongest association with hypertension. Our results suggest that BMI and WC offer useful markers for hypertension.