Association of triglyceride–glucose-based indices with the risk of elevated blood pressure and hypertension in a brazilian population

Insulin resistance (IR) is a central mechanism in hypertension (HTN) development, but its direct assessment is unfeasible in population studies. This cross-sectional study evaluated the association of surrogate IR indices – Triglyceride Glucose Index (TyG), Triglyceride Glucose-Body Mass Index (TyG-BMI), Triglyceride Glucose-Waist Circumference (TyG-WC), Triglyceride Glucose-Waist to Height Ratio (TyG-WHtR), Metabolic Score for Insulin Resistance (METS-IR), and Cardiometabolic Index (CMI) – with blood pressure (BP) stages: normal, elevated, and HTN. Using data from a population-based survey conducted between 2004 and 2005, including 1,365 Brazilian adults, clinical, anthropometric, and biochemical variables were analyzed through multivariable logistic regression models. TyG, TyG-BMI, TyG-WC, and TyG-WHtR were associated with higher BP categories. METS-IR showed inconsistent findings across analyses, whereas CMI demonstrated a positive correlation with systolic and diastolic BP. Most surrogate IR indices remained significantly associated with hypertension after adjustment for demographic, behavioral, anthropometric, clinical, and lipid-related variables, supporting an independent association with blood pressure status in this population. In fully adjusted models, TyG, TyG-BMI, TyG-WHtR, METS-IR and CMI remained significantly associated with hypertension, while the association with TyG-WC was attenuated. These findings suggest that surrogate insulin resistance indices may provide complementary information for identifying individuals at increased risk of hypertension in this Brazilian urban population. Although valuable as a historical record, the 2004–2005 context and the modest discriminatory performance of these indices highlight the need for contemporary longitudinal validation.