Association between hypertension status and severity and tinnitus: a cross-sectional analysis of the Fasa adult cohort study

Background Previous studies and meta-analyses suggest an association between hypertension and tinnitus; however, the influence of hypertension severity and control status remains unclear. Objective We aimed to investigate the association between hypertension and tinnitus in detail using a large, population-based dataset from a rural setting. Design Observational cross-sectional study. Setting Sheshdeh, Fasa, Iran. Participants We analysed data from 9775 individuals in the general population, aged 35–70 years, excluding those with a history of cancer, pregnancy or medical conditions known to cause tinnitus, such as stroke, seizures or multiple sclerosis. Additionally, although the study design aimed to exclude participants using aminoglycosides because of their significant ototoxic effects, no such users were identified during the study period. Primary and secondary outcomes Hypertension was defined as a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure (DBP) of ≥90 mm Hg on at least two separate measurements or as current use of antihypertensive medications following a prior diagnosis. These medications included ACE inhibitors, angiotensin receptor blockers, diuretics, aldosterone antagonists and atenolol. Stage I hypertension was classified as an SBP of 140–159 mm Hg or a DBP of 90–99 mm Hg, while stage II was defined as an SBP of ≥160 mm Hg or a DBP of ≥100 mm Hg. Controlled blood pressure was defined as values below these thresholds. Tinnitus, assessed by a self-reported questionnaire, was defined as a continuous wheezing sound in the ear persisting for more than 1 week. Results Among participants (4446 males, 5309 females; mean age 48.55 (SD 9.53) years), the prevalence of tinnitus and hypertension was 7.4% and 19.3%, respectively. Hypertension was significantly associated with higher odds of tinnitus (adjusted OR=1.34; 95% CI 1.10 to 1.62). Notably, even participants with controlled hypertension had a 27% increased odds (OR=1.27; 95% CI 1.02 to 1.59) compared with normotensive individuals. The odds were highest in those with uncontrolled grade II hypertension (OR=2.08; 95% CI 1.25 to 3.47), demonstrating a dose-response relationship. Conclusions Our findings suggest a positive association between hypertension and tinnitus, with odds increasing alongside the severity and poor control of hypertension. Importantly, even controlled hypertension was associated with elevated odds, indicating that tinnitus screening may be warranted in all hypertensive patients, regardless of control status. These results underscore the need for heightened clinical awareness and further research into the pathophysiological mechanisms linking vascular health and auditory symptoms.