Triglyceride-glucose index as a biochemical predictor of hypertension in patients with type 2 diabetes and prediabetes: Evidence from the NHANES database

Background: The triglyceride-glucose (TyG) index, derived from fasting triglyceride and glucose levels, has emerged as a reliable biochemical marker of insulin resistance. However, its relationship with hypertension (HTN) in diabetic and prediabetic populations remains insufficiently studied. Methods: Using data from 2,440 adults in the U.S. National Health and Nutrition Examination Survey (NHANES, 2011-2018), we investigated the association between the TyG index and HTN. Biochemical assays included enzymatic measurement of serum triglycerides (Beckman Coulter DxC800) and plasma glucose (hexokinase-based methods on Roche Cobas systems), from which the TyG index and related indices (TyG-BMI, TyG-WC, TyG-WHtR) were calculated. Logistic regression models adjusted for demographic, anthropometric, and biochemical covariates were used to estimate odds ratios (OR) for HTN risk. Results: Participants with HTN exhibited significantly higher TyG index levels compared with non-hypertensives (8.44 vs. 8.38, P< 0.01). In fully adjusted models, each unit increase in TyG was associated with a 31% higher risk of HTN (OR = 1.31, 95% CI: 1.02-1.69). Stratified analyses revealed significant associations among Mexican Americans and individuals without prior cardiovascular or hepatic disease. TyG-WC and TyG-WHtR indices also correlated positively with HTN risk, whereas TyG-BMI did not. Conclusions: Elevated TyG index and related biochemical indices are independently associated with increased HTN risk among individuals with diabetes or prediabetes. As a simple and reproducible biochemical parameter, the TyG index may serve as a valuable tool in laboratory medicine for early HTN risk identification and prevention strategies.