Associations of the uric acid–to–high-density lipoprotein cholesterol ratio with hypertension: a cross-sectional study from the China health and retirement longitudinal study

Hypertension is tightly linked to metabolic dysregulation, oxidative stress, and vascular dysfunction. The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has emerged as an integrated marker reflecting metabolic burden and oxidative stress. However, evidence regarding its association with hypertension remains limited in large, population-based samples. This cross-sectional study included 9,255 adults aged ≥45 years from the 2011 baseline survey of the China Health and Retirement Longitudinal Study (CHARLS). UHR was calculated as serum uric acid divided by HDL-C. Hypertension was defined as systolic/diastolic blood pressure ≥140/90 mmHg on examination, self-reported physician diagnosis, or current use of antihypertensive medication. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension per 1-standard deviation (SD) increment and across categories of UHR. Nonlinearity and potential inflection points were explored using restricted cubic splines and segmented regression. The mean age was 59.6 years, and 53.3% of participants were women. Overall, 3,844 individuals (41.5%) had hypertension. Each 1-SD higher UHR was associated with greater odds of hypertension (OR 1.21, 95% CI 1.15-1.28). Compared with participants in the low-UHR group, those in the high-UHR group had substantially higher odds of hypertension (OR 1.46, 95% CI 1.33-1.61). The association followed a nonlinear pattern; segmented regression suggested an inflection point at UHR = 9.09, with a steeper positive association at lower UHR values and attenuation at higher values. Higher UHR was independently associated with increased odds of hypertension, exhibiting a nonlinear exposure-response relationship. UHR may serve as a useful marker associated with hypertension among middle-aged and older adults.