Objective To analyze the multimorbidity and comorbidity patterns among hypertensive patients managed by family doctors in Shanghai, and to provide a theoretical basis for the precise management of hypertensive patients. Methods Based on the chronic disease integration management system, this study included 99 531 hypertensive patients managed by family doctors in Hongkou District, Shanghai, from October 2016 to December 2023. The Apriori algorithm and cluster analysis were used to explore the multimorbidity and comorbidity patterns, while the Web graph was used to visualize the non-random associations among chronic diseases. Results The proportion of hypertensive patients managed by family doctors in Shanghai was 93.93% (92 201 cases), with higher rates observed in women and older age groups (P < 0.001). A total of 76.00% (74 602 cases) patients had 2 to 6 comorbid conditions. Association rule mining showed that 12 strong association rules, primarily involving stroke, kidney disease, heart disease, diabetes disease, chronic lung disease, arthritis or rheumatism. There were 51 710 people in the main comorbidity pattern, and the top 3 patterns with higher incidence were: heart disease 50 185 people (97.05%), arthritis or rheumatism 36 250 people (70.10%), and chronic lung disease 31 590 people (61.09%). Conclusion The study highlights the importance of strengthening integrated chronic disease management for the community-based hypertension group. The study provides a reference for the improvement of assessment indicators in community management of hypertension, combination treatment of comorbidities and health management of comorbidities.