Nonlinear association between LDL/HDL ratio and hypertension: a cross-sectional analysis based on Chinese adults

Introduction: The link between low-density lipoprotein/high-density lipoprotein (LDL/HDL ratio, LHR) and the prevalence of hypertension in large populations, especially among individuals aged 20 and older, has not been extensively explored. This research aims to examine whether LHR is associated with hypertension prevalence. Methods: This retrospective cohort analysis drew on cross-sectional data from a health check-up database located in China. Hypertension is classified as a systolic blood pressure (SBP) of ≥ 140 mmHg or a diastolic blood pressure (DBP) of ≥ 90 mmHg. Multivariable logistic regression was used to examine the association between LHR and hypertension prevalence. Furthermore, a subgroup analysis was performed to assess how this association varied across different demographic categories. Results: The cross-sectional evaluation encompassed 113,912 participants. After adjusting for confounding variables, every unit rise in LHR correlated with an 11% increase in the prevalence of hypertension (Odds Ratio [OR] = 1.11, 95% Confidence Interval [CI]: 1.06, 1.16). Our findings indicated a nonlinear relationship between LHR and hypertension prevalence, with an inflection point at 2.28. Below this level, each unit increase in LHR was linked to a 168% heightened risk of hypertension, while above this point, the correlation became insignificant. The subgroup analysis indicated that females, older adults, non-smokers, and individuals with lower body mass index (BMI) exhibited a particularly high prevalence of hypertension associated with higher LHR levels. Conclusion: The findings suggest that a higher LHR serves as a notable predictor of hypertension and elevated blood pressure among Chinese adults aged 20 and older. The identified nonlinear relationship and threshold effect highlight the importance of LHR in hypertension screening and management.