<b><i>Introduction:</i></b> Little is known regarding the joint associations of famine exposure and obesity patterns with the incidence of hypertension. <b><i>Methods:</i></b> We defined famine exposure cohorts as follows: nonexposure (born between 1962 and 1965), fetal life exposure (born between 1959 and 1961), early childhood exposure (born between 1956 and 1958), midchildhood exposure (born between 1953 and 1955), and late childhood exposure (born between 1949 and 1952). Obesity patterns were defined as follows: G−/A−: subjects without neither general obesity nor abdominal obesity; G+/A− or G−/A+: subjects with either general obesity or abdominal obesity; G+/A+: subjects with both general obesity and abdominal obesity. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg or current treatment with antihypertensive medications. <b><i>Results:</i></b> There were 5,235 individuals participating in this study. In the subjects with general or abdominal obesity, famine exposure was associated with a lower risk of hypertension. In males with G−/A−, famine exposures in the midchildhood (<i>p</i> = 0.048; HR: 0.700; HR 95% CI: 0.491–0.998) and late childhood (<i>p</i> = 0.002; HR: 0.560; HR 95% CI: 0.374–0.840) were associated with a lower incidence of hypertension. <b><i>Conclusion:</i></b> The coexistence of famine exposure and obesity patterns was associated with the incidence of hypertension.