Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a lipid-based marker of hypertension: a large-scale cross-sectional investigation

Background Dyslipidemia is a known contributor to hypertension, yet the utility of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) for hypertension assessment remains unclear. We examined whether the NHHR is associated with hypertension and whether this association varies by demographic and metabolic characteristics. Methods This cross-sectional study included 10,735 adults who underwent health examinations. Participants were grouped by NHHR quartiles. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the association between NHHR and hypertension. Results Hypertension was present in 32.8% of participants. Each one-unit increase in NHHR was not significantly associated with hypertension in the unadjusted model (PR 0.99, 95% CI 0.96–1.03, P = 0.735). After adjustment for age, sex, and eGFR, the association became significant (PR 1.09, 95% CI 1.05–1.12, P < 0.001), with participants in the highest quartile having 24% higher prevalence compared with the lowest (PR 1.24, 95% CI 1.13–1.37, P < 0.001). However, after additional adjustment for BMI, the association was substantially attenuated (PR 1.03, 95% CI 1.00–1.07, P = 0.068). These findings were robust across sensitivity analyses. Conclusions An elevated NHHR was associated with hypertension after adjustment for demographic factors, but this association was substantially attenuated by BMI, suggesting that adiposity largely accounts for the observed relationship. The NHHR may serve as a convenient lipid-related marker, but its clinical utility for screening requires further investigation.