The Relationship Between Waist‐to‐Hip Ratio and the Risk of Hypertension

Background: The association between waist‐to‐hip ratio (WHR) and hypertension remains controversial, especially among participants with normal BMI. This study attempted to further elucidate the causal relationship between WHR and hypertension through combined NHANES and two‐sample Mendelian randomization (MR) analysis. Methods: Weighted multivariate logistic regression analysis was used to investigate the relationship between WHR and hypertension. Inverse variance weighting (IVW) was used as the primary method. The UK Biobank (UKB) cohort was used as a discovery study. And the Finn cohort was used as a replication study. Multivariate MR (MVMR) analysis was used to further exclude redundant factors. Results: A total of 45,086,542 weighted records (870 unweighted) with normal BMI were enrolled in the NHANES analysis. After adjusting for potential confounders, subjects in the higher quartiles of WHRs had a higher risk of hypertension (Q2 OR = 2.744 [95% CI, 1.139–6.61], Q3 OR = 3.665 [1.291–10.405], and Q4 OR = 5.58 [95% CI, 1.723–18.068]). The random‐effects IVW results showed that higher WHR increased the risk of hypertension in the UKB discovery cohort (OR = 1.0295 [95% CI, 1.0204–1.0387]) and the Finn replication cohort (OR = 1.275 [95% CI, 1.1587–1.4029]). In the MVMR analysis, after adjusting for height and BMI, the IVW results showed that higher WHR increased the risk of hypertension in the UKB cohort (OR = 1.0312 [95% CI, 1.0205–1.0421]) and the Finn cohort (OR = 1.27 [95% CI, 1.1036–1.4615]). Conclusion: Our study provided sufficient evidence for the causal relationship between higher WHR and hypertension in participants with normal BMI.