Association between triglyceride-glucose index and elevated blood pressure among U.S. adolescents aged 12–17

The triglyceride-glucose (TyG) index is a known cardiovascular risk factor in adults, but its association with elevated blood pressure (EBP) in adolescents remains unclear. We hypothesized that the TyG index is associated with EBP among U.S. adolescents aged 12–17 years. This cross-sectional analysis included 4409 adolescents from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. We used weighted multivariate logistic regression, weighted subgroup analysis, threshold effect and smoothing curve fitting to examine the association between the TyG index and EBP. Among the participants, 661 (14.9%) had EBP. After full adjustment, each unit rise in TyG index significantly boosted EBP odds (OR = 4.45, 95% CI 1.34–14.78, P = 0.02). A nonlinear relationship was observed, with an exploratory inflection point of the TyG index at 7.98. In BMI-stratified analyses, the association remained significant only among adolescents with BMI < 25 kg/m² (OR 3.09; 95%CI: 1.55–6.18; P < 0.01). Subgroup analyses revealed no significant interactions (all P for interaction >0.05). TyG index was cross-sectionally associated with EBP in U.S. 12–17-year-olds, with an exploratory inflection point. This suggests a potential low-cost indicator for risk stratification of adolescents with higher odds of EBP, pending verification in longitudinal studies. The triglyceride-glucose (TyG) index is cross-sectionally associated with elevated blood pressure (EBP) in U.S. 12–17-year-old adolescents, with an exploratory inflection point of 7.98. This study explores a TyG index exploratory inflection point for adolescent EBP risk in a nationally representative sample. TyG index, a routine and low-cost biomarker, presents potential utility for early risk stratification of adolescent EBP, although further prospective validation is required. The non-linear TyG index-EBP association highlights the potential need for age-specific metabolic risk stratification in adolescents.