Association analysis of weight-adjusted waist index with hypertension and its subtypes

Background Hypertension is a leading global risk factor for cardiovascular diseases, with notable regional differences in China. The weight-adjusted waist index (WWI), a novel indicator of central obesity, shows potential in assessing health risks but its link to hypertension subtypes, especially in northeastern China, remains underexplored. Methods Using a stratified multistage random sampling approach, we enrolled 6,974 permanent residents aged ≥18 years from six cities in Jilin Province (2021–2022). Multivariate logistic regression examined associations between WWI quartiles and hypertension subtypes. Mediation analysis assessed the potential mediating effects of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Results After comprehensive adjustment, the highest WWI quartile (Q4) demonstrated significant associations with overall hypertension risk (adjusted OR = 1.974, 95% CI: 1.611–2.420). Subtype analysis revealed maximum effect sizes for systolic-diastolic hypertension (OR = 2.448, 95% CI: 1.827–3.281), whereas no significant association was observed with isolated diastolic hypertension. Mediation analysis indicated that HDL-C and LDL-C partially mediated the relationship, with mediated proportions of 2.35 and 3.92%. Notably, HDL-C fully mediated IDH (18.2%). ROC analysis showed that WWI had comparable predictive performance to BMI and WC for ISH ( p > 0.05). Conclusion WWI is positively associated with hypertension, particularly SDH, in Northeast Chinese adults. These findings highlight the importance of targeting central obesity in hypertension management. Prospective cohort studies are needed to confirm the temporal relationship and evaluate the clinical utility of WWI.