Hao Sun, Yuan Liu
Composite indices integrating visceral adiposity, insulin resistance, and lipid burden were associated with prehypertension and hypertension. They may help characterize cardiometabolic risk clustering but are not substitutes for direct blood pressure measurement or diagnostic evaluation. These findings support association and screening-value inference, not causal or diagnostic claims.
BACKGROUND: Prehypertension and hypertension are cardiovascular risk states. We examined whether biomarker-derived atherogenic, cardiometabolic, and adiposity indices were associated with blood pressure status in adults undergoing health examinations.
METHODS: This hospital-based cross-sectional study included 2, 136 adults from the Health Examination Center of the Second Affiliated Hospital of Shandong First Medical University between 2024 and 2025. Blood pressure was classified as normal, prehypertension, or hypertension. Composite indices were reconstructed from anthropometric, biochemical, and questionnaire variables. Analyses included multivariable regression, quartiles, 3-knot restricted cubic splines, mixture analysis, incremental evaluation, explainable machine learning, subgroup analyses, and sensitivity analyses.
RESULTS: The cohort included 983 participants with normal blood pressure (46.02%), 422 with prehypertension (19.76%), and 731 with hypertension (34.22%). In fully adjusted analyses, CVAI (OR, 2.17 (1.80-2.62); P<0.01), TyG-WC (OR, 1.94 (1.64-2.28); P<0.01), TyG-BMI (OR, 1.93 (1.66-2.26); P<0.01), and METS-IR (OR, 1.91 (1.63-2.24); P<0.01) showed the strongest standardized associations with abnormal blood pressure. The highest quartiles of CVAI, METS-IR, and TyG-WHtR had higher odds than the lowest quartiles (all P for trend <0.01). Cross-validated AUROC improved from 0.80 to 0.83 after adding clinical and index information. SHAP highlighted CVAI, age, fasting glucose, waist circumference, eGFR, and uric acid.
CONCLUSIONS: Composite indices integrating visceral adiposity, insulin resistance, and lipid burden were associated with prehypertension and hypertension. They may help characterize cardiometabolic risk clustering but are not substitutes for direct blood pressure measurement or diagnostic evaluation. These findings support association and screening-value inference, not causal or diagnostic claims.