Association between waist-height ratio and hypertension: results from the lookup 8+ study

Introduction: Hypertension is the leading cardiovascular disorder, with central adiposity among its key modifiable determinants. The waist-height ratio (WHtR) has been proposed as an index of central adiposity, yet its association with hypertension and its comparative utility for hypertension screening remains incompletely defined. This study investigated association between WHtR and hypertension and compared its discriminatory performance with body mass index (BMI) and waist-hip ratio (WHR). Methods: A total of 14,415 community-dwelling adults were included in the analysis. Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg, and/or current antihypertensive therapy. Binomial and multivariate generalized linear models (GLM) assessed association between WHtR and blood pressure, adjusting for sex, age, and five health metrics. ROC curve analyses with DeLong pairwise comparisons evaluated discriminatory performance, stratified by sex. Results:Abnormal WHtR (n = 8,731) was significantly associated with higher SBP (130 vs. 120 mmHg; p < 0.001) and DBP (80 vs. 70 mmHg; p < 0.001), and with greater hypertension prevalence, particularly in older and male participants. Sex-adjusted GLM showed abnormal WHtR negatively associated with normal blood pressure (OR 0.25; p < 0.001), persisting after full adjustment (OR 0.44; p < 0.001). Continuous GLM confirmed positive associations with SBP (β = 6.11 per 0.1-unit increment; p < 0.001) and DBP (β = 2.36; p < 0.001). WHtR demonstrated superior discriminatory accuracy over BMI and WHR overall (AUC 0.7285 vs. 0.6901 vs. 0.6869) and across both sexes, confirmed by DeLong comparisons. Conclusion: WHtR outperforms BMI and WHR in identifying individuals with hypertension across both sexes, supporting its evaluation for cardiovascular screening in community settings.