Objective:To assess the mediating effects of obesity and metabolic factors in the relationship between hyperuricemia (HUA) and prehypertension.Methods:A total of 9 399 individuals were selected using a multistage stratified whole-group random sampling method from 90 villages (neighborhood committees) in 30 towns (streets) of 5 districts (counties) in Fuzhou. A total of 4 754 study subjects were included. A linear regression model was used to analyze the association of HUA with obesity and metabolic factors. Single-factor and multi-factor logistic regression models were used to analyze the association of HUA, obesity, and metabolic factors with prehypertension. Mediating effects models were used to analyze the mediating effects of obesity and metabolic factors on the association between HUA and prehypertension.Results:After adjusting for confounders, the association between HUA and cholesterol, triglycerides, HDL-C, LDL-C, BMI, waist circumference, creatinine, and urea nitrogen were significantly correlated ( P<0.001). HUA, waist circumference, BMI, and triglycerides were significantly associated with prehypertension ( P<0.001). Waist circumference, BMI, and triglycerides mediated the relationship between HUA and prehypertension, with OR (95% CI) of 1.018 (1.007-1.027), 1.010 (1.002-1.018), and 1.010 (1.003-1.017) ( P<0.001), with mediating proportions of 7.76%, 4.31%, and 4.31% respectively. No mediating effect of cholesterol, HDL-C, LDL-C, creatinine, and urea nitrogen was found on the relationship ( P>0.05). Conclusions:Waist circumference, BMI, and triglycerides all had mediating effects in the association between HUA and prehypertension. For the general population, weight control, waist circumference, and a high-fat diet should be used to reduce the occurrence of prehypertension.