Correlation between Chinese visceral adiposity index and incidence of hypertension across different blood pressure status: a cohort study

Hypertension is a significant global public health issue and its pathogenesis is strongly associated with visceral obesity. The Chinese Visceral Adiposity Index (CVAI), a well-established indicator based on the metabolic profile of Asian populations, has been linked to an increased risk of hypertension. However, there is a lack of comprehensive evidence regarding the differential relationship between the CVAI and the incidence of hypertension in participants with normal vs. elevated blood pressure (BP). This study aimed to utilize longitudinal data to examine the association between the CVAI and the incidence of hypertension across populations with different baseline BP levels. Data from the China Health and Retirement Longitudinal Study (CHARLS) database were used for this retrospective cohort analysis. Participants aged ≥45 years without hypertension at baseline (2011) were included and followed up until 2020 to assess the incidence of hypertension. The CVAI was calculated using a sex-specific formula incorporating age, waist circumference (WC), body mass index (BMI), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C). Multivariate logistic regression and restricted cubic spline (RCS) models were used to evaluate the nonlinear association between CVAI and hypertension risk. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of CVAI. For the sensitivity analyses, univariate RCS models were employed to assess the robustness of the findings. Among 5311 participants, 1,819 (34.25%) developed hypertension during the 9-year follow-up period. CVAI emerged as an independent risk factor for incident hypertension. Comparing the highest to the lowest quartile of CVAI, the adjusted odds ratio (OR) was 1.77 (95% CI: 1.32–2.38) in the normal BP group and 3.21 (95% CI: 2.26–4.61) in the elevated BP group. A linear dose-response relationship was observed between CVAI and hypertension risk in both groups. These associations remained robust and linear in sensitivity analyses after excluding participants with diabetes, heart disease, or stroke. Clinically, CVAI offers a simple, low-cost tool to improve hypertension risk stratification and enable earlier targeted prevention, particularly among individuals with elevated BP.