Health‐Related Physical Fitness Associated With Hypertension Risk in Adults Living in Sub‐Plateau Environments

This study aimed to investigate the associations between health-related physical fitness (HPF) indicators and hypertension (HTN) risk among adults living in sub-plateau regions and to explore gender-specific differences, providing empirical evidence for cardiovascular health promotion and intervention. A cross-sectional study was conducted from 2020 to 2022 in Ningxia, China, recruiting 3026 adults aged 20-59 years (1328 males and 1698 females). Ten HPF indicators across five dimensions, including body composition (body mass index, BMI; waist-to-hip ratio, WHR; waist-to-height ratio, WHtR), cardiorespiratory endurance (vital capacity, VC), muscular strength (grip strength, GS; back strength, BS; vertical jump, VJ), muscular endurance (push-ups/knee push-ups, PU/KPU; sit-ups, SU), and flexibility fitness (sit-and-reach, SAR). Binary logistic regression was used to identify HTN-related indicators, and receiver operating characteristic (ROC) analyses were performed to evaluate their predictive ability. The results showed that the prevalence of HTN was 26.75% in males, significantly higher than 18.36% in females (p < 0.05), both lower than the national average (males: 36.8%, females: 26.3%). Regarding the association, in males, BMI (odds ratio, OR = 1.120) and WHtR (OR = 1.673) were positively associated with HTN risk (p < 0.05), whereas SAR (OR = 0.975) showed a negative association (p < 0.05). In females, WHR (OR = 1.240) was positively associated with HTN (p < 0.05), while SU (OR = 0.960) showed a negative association (p < 0.05). ROC analysis indicated that WHtR and WHR were the best single predictors for males (area under the curve, AUC = 0.662) and females (AUC = 0.633), respectively, while combined indicators (BMI + WHtR + SAR in males; WHR + SU in females) further improved discrimination (AUC = 0.679 and 0.655). In conclusion, adults in the sub-plateau region exhibited a lower prevalence of HTN with notable gender differences. WHtR and WHR are the most valuable gender-specific screening indicators, and combined indices enhance predictive accuracy, offering practical guidance for early HTN prevention and management in sub-plateau populations.