Anthropometric and cardiometabolic indicators of hypertension in Ghana: evidence from the CarMeR study

Hypertension affects nearly half of adults in many low- and middle-income countries, yet effective screening remains difficult due to limited resources. This study identified anthropometric and cardiometabolic markers associated with hypertension among Ghanaian adults to inform practical screening strategies. This cross-sectional study analysed data from 1,200 individuals aged 25 and above from the Cardiometabolic Risks (CarMeR) project in Cape Coast, Ghana. Cardiometabolic markers (fasting blood sugar, glycated haemoglobin, 2-hour plasma glucose, lipid profile, uric acid) and anthropometric measurements (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, body fat percentage) were assessed. Independent predictors were identified using logistic regression models, and discriminative performance was evaluated through receiver operating characteristic analysis, stratified by age and sex. Among 1200 participants (mean age 46.95 years and 66.33% female) hypertension prevalence was 47.5%. In fully adjusted models, fasting blood sugar (adjusted odds ratio [AOR] = 1.19, 95% CI: 1.01–1.44), 2-hour plasma glucose (AOR = 1.05, 95% CI: 1.01–1.09), and uric acid (AOR = 1.12, 95% CI: 1.02–1.23) were independently associated with hypertension. For anthropometric measures, waist circumference was independently associated (AOR = 1.03, 95% CI: 1.02–1.05), whereas other adiposity indices were significant only when examined individually. The combined model achieved modest-to-acceptable discrimination in both males (AUC = 0.708) and females (AUC = 0.770), with most individual indicators performing only marginally above chance. Sex-stratified analyses indicated body fat percentage was significant only in females, while fasting blood sugar and uric acid were significant only in males. Age-stratified analyses cardiometabolic indicators were stronger predictors among middle-aged and older adults. Cardiometabolic indicators and waist circumference were independently associated with hypertension, while other adiposity indices showed associations primarily when examined individually. Combined screening models showed modest-to-acceptable discriminative ability for population-level screening. Age- and sex-specific associations support tailored screening approaches incorporating anthropometric and metabolic assessments in resource-limited settings.