OBJECTIVE: To investigate the relationship between obesity-related indices and target organ damage in hypertension, with the goal of improving damage prevention and treatment strategies. METHODS: This retrospective study included 150 hypertension cases from January 2022 to December 2023 treated at Beijing Ditan Hospital, including 72 cases of isolated hypertension, 48 with hypertension complicated by kidney damage, 47 with hypertension and left ventricular hypertrophy, and 44 with hypertension and carotid atherosclerosis. Clinical indicators and obesity-related indices were collected to analyze their correlation with target organ damage in hypertension. RESULTS: A Body Shape Index (ABSI) (OR: 1.003 [1.001-1.913], P=0.007), BMI (OR: 1.054 [1.005-1.694], P=0.023), and BRI (OR: 0.562 [0.287-0.934], P=0.034) were independently associated with hypertensive kidney damage. Age (OR: 1.037 [1.000-1.635], P=0.034), ABSI (OR: 0.901 [0.882-0.998], P=0.034), and blood pressure grading (OR: 1.473 [1.175-1.845], P=0.002) were independent risk factors for hypertensive left ventricular hypertrophy. ABSI (OR: 1.012 [1.001-1.623], P=0.032) and smoking history (OR: 0.892 [0.781-0.998], P=0.021) were independent risk factors for hypertensive carotid artery plaque formation. CONCLUSION: ABSI is an independent risk factor for target organ damage in hypertension.