Association between sarcopenia and hypertension: results from large databases in China and the United States

Sarcopenia and hypertension are prevalent conditions with substantial public health implications. However, whether their association is consistent across different populations remains unclear. This study aimed to investigate the association between sarcopenia and hypertension using nationally representative cohorts from China and the United States. Data from the China Health and Retirement Longitudinal Study (CHARLS) and the National Health and Nutrition Examination Survey (NHANES) were analyzed. Sarcopenia was defined according to NIH criteria using ASM/BMI in CHARLS and ALM/BMI in NHANES. Multivariable logistic regression and modified Poisson regression with robust variance estimation were performed to estimate ORs and PRs. Among 22,082 CHARLS and 9,213 NHANES participants, sarcopenia was associated with higher odds of hypertension in logistic regression (NHANES: OR = 1.65, 95% CI: 1.32–2.07; CHARLS: OR = 1.71, 95% CI: 1.11–2.62). Modified Poisson regression yielded consistent associations with attenuated effect estimates (NHANES: PR = 1.30, 95% CI: 1.16–1.46; CHARLS: PR = 1.24, 95% CI: 1.05–1.46). Higher continuous muscle mass indices were consistently associated with lower odds and prevalence of hypertension, with significant dose–response relationships observed across tertiles (all P for trend < 0.001). Exploratory interaction analyses identified effect modification by smoking status in NHANES ( P for interaction = 0.022) and by age in CHARLS ( P for interaction = 0.002) under the modified Poisson framework. Sarcopenia was associated with higher hypertension prevalence, whereas greater relative muscle mass was associated with lower prevalence across Chinese and US populations. Consistent findings from logistic and modified Poisson models support the robustness of these associations. However, causal inference is limited by the cross-sectional design and differences in muscle mass assessment methods. Future longitudinal studies using standardized measurements are warranted.