Association of remnant cholesterol with new-onset hypertension among middle-aged and older adults in China

Although remnant cholesterol has been associated with cardiovascular disease, the risk of remnant cholesterol and blood pressure remains unclear. This study aimed to investigate the association between remnant cholesterol and new-onset hypertension. We used middle-aged and older adults aged ≥ 45 years from the first three waves of the China Health and Retirement Longitudinal Study (CHARLS). Estimated remnant cholesterol was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. Multiple linear regression analysis and Cox proportional hazards modeling were used to assess the association between remnant cholesterol levels and blood pressure levels and new-onset hypertensive events, respectively. Nonlinear associations were assessed using restricted cubic spline models. A total of 3,044 participants were included, and 839 new-onset hypertensive events (76.5 events per 1000 person-years) were documented during a median follow-up period of 4.0 years. After adjustment for age, sex, lifestyle factors, and other cardiovascular risk factors, compared with participants with normal-range (< 31 mg/dl), those with significantly elevated (≥ 46 mg/dl) remnant cholesterol had elevated systolic blood pressure by 2.36 (95% confidence interval [95% CI]: 0.55, 4.17) mmHg and diastolic blood pressure by 1.66 mmHg (95% CI: 0.47, 2.84), and the risk of new-onset hypertension was 28% higher (hazard ratio [HR]: 1.28; 95% CI: 1.03, 1.59), with no significant association observed in the mildly elevated group (31-46 mg/dl). This association showed similar results in different subgroups. Elevated remnant cholesterol is significantly associated with blood pressure levels and risk of new-onset hypertension, suggesting that remnant cholesterol might be a potential therapeutic target for hypertension prevention.