According to the 2018 Chinese Guidelines for Prevention and Treatment of Hypertension[22], This research predicts the risk index of hypertension in middle-aged and elderly people in China by the 13 obesity-related indexes. It is a novel one. We know that before this, there was no research paper to evaluate the most suitable index to predict the risk of hypertension by comparing 13 obesity and lipid-related index. This study included 9488 male and female participants over 45 years old. Among the 9488 subjects, the proportion of hypertension was 41.15%. Among the 4354 males, 1742(40.01%) and 5134 females, 2162(42.11%) suffered from hypertension. Based on the entire country's investigation[3], the prevalence of high blood pressure among adults in China is about 23.2%, among which the prevalence of hypertension increases with age, the prevalence of hypertension in the population aged 65 and over is over 55%, and the prevalence rate in men is higher than that in women. Therefore, it is necessary to find a more suitable obesity-and lipid-related index to predict the incidence of hypertension in middle-aged and elderly people in China.
Table 3 shows that the ABSI is significantly related to hypertension in men, after adjusting the individual characteristics, but it is not statistically significant in women. Some studies [37, 46–48] show that ABSI is lower than other indicators in relation to hypertension, which is consistent with the results of this study. It is worth noting that the data in Table 4 shows that ABSI still has reference significance in predicting the incidence of hypertension among middle-aged and elderly people in China. However, ABSI's prediction ability is far lower than the other 12 indexes. Cheung, Y.B[47] study showed that compared with WC and BMI, ABSI was less associated with middle-aged and elderly morbidity. Because the deviation of ABSI from its average value is low, ABSI is not significant in predicting the incidence of hypertension[49]. After adjusting the individual characteristics, the odds ratio (OR) and 95% CI of various obesity- and lipid-related indices to hypertension were calculated, and all reached statistical significance (P < 0.05).
ROC analysis of obesity- and lipid-related indices showed that the AUC of all indexes of male and female was statistical meaning (P < 0.05). Among the 13 indexes, CVAI, WHtR, BRI, and TyG -WHtR have received special attention.
In a cross-sectional study[50] of 14,573 participants, VAI was a better predictor of hypertension in both men and women. VAI proposed by Amato M.C can effectively evaluate visceral fat function[36]. A study conducted by Fiorentino, T.V[51] to test the risk factors related to the progression of hypertension in patients with prehypertension showed that VAI was an independent risk factor for the progression of hypertension. However, the significant overlap of confidence intervals of VAI did not mean that VAI was superior to other obesity indicators in predicting the development of hypertension. Notably, the combination of VAI and WC shows the highest predicted values for hypertension. This conclusion is consistent with the results of a cohort study[52] conducted in Chengdu, Sichuan Province, China. It can be analyzed for the following reasons: the difference of body fat distribution between different races is also obvious. According to the distribution law of body fat in Asian population, Xia, M. F. put forward the index of CVAI based on VAI to calculate the visceral fat area of China people[41]. In this study, compared with VAI, CVAI is more prominent in evaluating the prevalence of hypertension in middle-aged and elderly people in China.
A cohort study[53] of 10,304 Chinese adult residents showed that CVAI outperformed other measures of visceral obesity in predicting the incidence of hypertension in either men or women. A study by Li, B[54] has shown that CVAI is more effective in discriminating hypertension and prehypertension among the general population in China. Similarly, Lin, M[55], in a 2022 cohort of 2, 033 participants, showed that CVAI performed best in predicting hypertension. In this study, ROC analysis was performed on obesity-and lipid-related indicators, maximum AUC (male: AUC = 0.660, 95% CI = 0.643–0.676 and optimal cut-off = 111.142, female: AUC = 0.699, 95% CI = 0.685–0.713, and optimal cut-off = 113.022) was observed for the CVAI. CVAI showed the best ability to predict the occurrence of hypertension in both men and women. This conclusion has corresponded with the conclusion of the previous study.
WHtR and BRI have obvious advantages in forecasting the incidence of hypertension in middle-aged and elderly people[56]. In this study, WHtR and BRI are indicators for predicting the occurrence of hypertension, and their prediction ability is second only to CVAI. Lee, J. W[57] study showed that WHtR and WC were superior to BMI as screening tools in forecasting the incidence of hypertension in middle-aged and elderly Koreans. At the same time, A prospective cohort study[58] of 812 participants showed that WHtR had a significant advantage over WC, and BMI in predicting the development of hypertension. Similarly, in a cross-sectional study by Saeed, A. A[59], WHtR was the best predictor of hypertension among various anthropometric measures. These studies are basically consistent with the view of this paper that WHtR has a good performance in predicting the occurrence of hypertension.
Some obesity-and lipid-related indices provide a more reliable basis for predicting the occurrence of hypertension. In this study, the association strength between four lipid indexes, such as TyG index, TyG- body mass index, TyG-WC and TyG-WHtR, and hypertension was evaluated. In fact, a large number of studies[60–63] have shown that there is a significant relationship between TyG related factors and hypertension. In this study, the ability of WHtR (AUC = 0.651, 95% CI = 0.635–0.668) and TyG-WHtR (AUC = 0.651, 95%CI = 0.634–0.667) to predict the occurrence of hypertension in men was approximately the same. But in women, the prediction ability of TyG-WHtR (AUC = 0.674, 95%CI = 0.660–0.689) was superior to WHtR (AUC = 0.664, 95%CI = 0.649–0.679). Therefore, TyG-WHtR is more accurate than WHtR in predicting the occurrence of hypertension in the middle-aged and elderly population in China.
BRI has the sufficient discriminating ability to discriminate hypertension from the normotensive population[64]. Chang, Y study[65] of two new measures to identify high blood pressure reported a low association with ABSI and the strongest association with BRI. A study[66] that predicted risk factors for cardiovascular disease in China reported that BRI was superior to other indicators in its predictive power. It should be noted that BRI and WHTR did not show a significant difference in both men and women.
Strengths and limitations of the study
This study has several advantages. This study was based on a nationwide cohort study of middle-aged and older community residents, with participants aged 45 years or older. It compared the effect of different obesity-and lipid-related indices hypertension and its components symptom. Previous studies used only a set of single indices to predict the Incidence of hypertension. It helped us to understand the different obesity-and lipid-related indices on the incidence of hypertension. There are several limitations to this study. Many participants were excluded due to missing data, and further studies should gather more complete data.