Associations of insulin resistance surrogate with resistant hypertension and the severity of hypertension in the chronic kidney disease population

Background: Extensive research has explored the relationship between the triglyceride–glucose (TyG) index and hypertension, yet the associations of the TyG index with resistant hypertension and the severity of hypertension in the chronic kidney disease (CKD) population remain unclear. Methods: We analyzed data from 3944 CKD participants in the NHANES survey (1999–2020). Binary and ordered logistic regression analyses assessed the TyG index's impact on hypertension categories (uncontrolled, resistant, and refractory hypertension) and severity. Results: Higher TyG index quartiles were significantly associated with higher odds of hypertension categories after adjustments for covariates. Specifically, the odds ratios (ORs) for the highest quartile were 1.68 (1.27–2.22) for uncontrolled hypertension, 2.24 (1.41–3.58) for resistant hypertension, and 2.17 (1.18–3.99) for refractory hypertension compared to the lowest quartile. The continuous TyG index showed similar trends, with ORs of 1.28 (1.10–1.49), 1.54 (1.23–1.94), and 1.40 (0.97–2.01), respectively. Higher TyG index levels were also linked to greater hypertension severity. The ORs (Q2, 3, 4 vs. Q1) were 1.29 (1.01–1.65), 1.37 (1.10–1.72), and 1.80 (1.40–2.32), respectively. Each one-unit increase in the TyG index raised the OR for hypertension severity to 1.34 (1.17–1.53). Conclusion: This study demonstrated that an elevated TyG index is significantly associated with higher odds of uncontrolled, resistant, and refractory hypertension, as well as greater severity of hypertension. The findings underscored the utility of the TyG index as a valuable biomarker for evaluating resistant hypertension risk and hypertension severity among patients with CKD in community settings.