The association between obesity indices and hypertension in adults with different glycemic status

Obesity and hypertension (HTN) frequently coexist with dysglycemia, yet it remains unclear whether general (BMI) versus central (waist circumference, WC) obesity indices show differential associations with HTN across normoglycemic, prediabetic, and diabetic states. This population-based study aimed to assess this relationship among adults aged 35 to 70 from the Bandare-Kong cohort. HTN was determined based on systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or self-reported use of antihypertensive medication. Obesity was defined by body mass index (BMI) ≥30 kg/m2 or WC ≥102 cm in men and WC ≥88 cm in women. Participants were stratified as normoglycemic (fasting plasma glucose [FPG] < 100 mg/dL), prediabetic (FPG 100-125 mg/dL), or diabetic (self-reported diabetes or FPG ≥126 mg/dL). Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Of 3916 participants (mean age 48.3 years; 42.8% male), 60.1% were normoglycemic. Multivariable analysis indicated that among diabetic individuals, high WC alone (aOR = 3.19, 95% CI: 1.18-5.60, P < .01) and combined obesity (aOR = 3.09, 95% CI: 1.77-5.39, P < .01) were associated with higher odds of HTN. The high-BMI-only category among diabetic participants was not interpreted inferentially because it contained only 2 normotensive individuals, resulting in an unstable estimate. In the prediabetic group, participants with combined obesity had the highest odds of HTN (odds ratio = 2.53, 95% CI: 1.58-4.15, P < .01), followed by those with high WC alone (odds ratio = 1.99, 95% CI: 1.21-3.27, P < .01). Among normoglycemic individuals, combined obesity was associated with higher odds of HTN (aOR = 2.63, 95% CI: 2.01-3.44, P < .01), followed by high WC alone (aOR = 1.44, 95% CI: 1.10-1.86, P < .01). Central obesity, either alone or combined with general obesity, was consistently associated with higher odds of HTN across glycemic strata. These findings support the importance of WC-based obesity assessment in HTN risk evaluation. Longitudinal studies with adequately sized diabetic subgroups are needed to confirm these associations and establish temporality.