Association between cumulative biological risk and hypertension in older adults in Korea: a population-based cross-sectional study

Q: What are the key findings of this study?

A high cumulative biological risk score was significantly associated with nearly three times higher odds of hypertension (OR 2.92) compared to a low-risk score among older adults in Korea.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=1551). Intervention: High cumulative biological risk score (CBRS ≥ 3) vs. Low cumulative biological risk score (CBRS = 0). Primary outcome: Hypertension (self-reported physician-diagnosed) (OR 2.92, 95% CI 1.87-4.54, p=<0.001).

Q: What does this research mean for the field?

A high cumulative biological risk score is significantly associated with nearly three times higher odds of hypertension compared to a low-risk score among older adults in Korea. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the association between cumulative biological risk score and hypertension among older adults using nationally representative survey data.

Hyemin Hwang; Kyeongmin Jang

doi:10.7586/jkbns.26.026

August 26, 2026Journal of Korean Biological Nursing ScienceOpen Access

Association between cumulative biological risk and hypertension in older adults in Korea: a population-based cross-sectional study

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Key result

High cumulative biological risk score linked to ~192% higher hypertension odds versus low risk.

OR 2.92
95% CI 1.87-4.54
P<0.001
n=1,551

Why the study?

The study was conducted to examine the association between cumulative biological risk and hypertension among older adults in Korea using nationally representative data.

Does a higher cumulative biological risk score increase the odds of hypertension in older adults?

Key Points

To examine the association between cumulative biological risk score and hypertension among older adults using nationally representative survey data.
Analyzed 1,551 adults aged 65 years or older from the 2024 Korea National Health and Nutrition Examination Survey.
Calculated a cumulative biological risk score (CBRS) using five indicators: anemia, HbA1c ≥ 5.7%, BMI ≥ 25 kg/m2, hs-CRP ≥ 3 mg/L, and vitamin D < 20 ng/mL, with hypertension defined as self-reported physician diagnosis.
Conducted complex sample logistic regression (final model N = 1,546) incorporating sampling weights, stratification, and cluster variables.
Compared with the low-risk CBRS group, higher odds of hypertension occurred in the moderate-risk group (OR = 1.67, 95% CI = 1.16–2.40, p = .006) and high-risk group (OR = 2.92, 95% CI = 1.87–4.54, p < .001).
Individual components differing significantly by hypertension status were HbA1c ≥ 5.7% (65.0% vs. 52.1%, p < .001) and BMI ≥ 25 kg/m2 (46.3% vs. 24.5%, p < .001), while anemia (p = .083), hs-CRP ≥ 3 mg/L (p = .076), and vitamin D deficiency (p = .075) did not.
Hypertension was also independently associated with older age (OR = 1.06, 95% CI = 1.04–1.09, p < .001), monthly alcohol use (OR = 1.33, 95% CI = 1.03–1.72, p = .031), and lack of aerobic physical activity (OR = 1.42, 95% CI = 1.08–1.87, p = .013).

Study Design

Type

Cross-Sectional (n=1,551)

Structured PICO

Does a higher cumulative biological risk score increase the odds of hypertension in older adults?

P

Population

1,551 adults aged 65 years or older from a nationally representative Korean survey were assessed for the association between cumulative biological risk and hypertension.

E

Exposure

Moderate (1-2 indicators) or high (≥3 indicators) cumulative biological risk score (CBRS) based on five indicators: anemia, HbA1c ≥ 5.7%, BMI ≥ 25 kg/m2, hs-CRP ≥ 3 mg/L, and vitamin D < 20 ng/mL.

C

Comparator

Low-risk group (CBRS = 0 indicators).

O

Outcome

Self-reported physician-diagnosed hypertension.

Main Result

Odds Ratio: 2.92 (95% CI 1.87–4.54)

p-value: p=<0.001

A higher cumulative biological risk score is significantly associated with increased odds of hypertension in older Korean adults, suggesting that later-life hypertension is linked to clustered biological and metabolic dysregulation.

Limitations

Cross-sectional design prevents causal inference, and reverse causation cannot be excluded.
Hypertension was defined based on self-reported physician diagnosis, which may underestimate undiagnosed hypertension.
The CBRS and its risk categories were constructed using predefined cutoff values for interpretability and have not been clinically validated.
Each CBRS component was assigned an equal weight despite potentially differing contributions to hypertension-related risk.
Potentially relevant factors, including antihypertensive medication use, dietary sodium intake, kidney function, and detailed alcohol consumption patterns, were not fully considered.
The CBRS was not developed or validated as a clinical screening or prediction tool.
The observed association between CBRS and hypertension may have been influenced substantially by glycemic dysregulation and obesity rather than reflecting equal contributions from all five components.
The CBRS has not been validated as a clinical screening or prediction tool.
Sensitivity, specificity, discrimination, calibration, and optimal cutoff were not evaluated.

Implication

May inform risk stratification in older Korean adults; leaves open causal inference and prospective validation of CBRS.

Abstract

Purpose This study examined the association between cumulative biological risk and hypertension among older adults in Korea using nationally representative data. Methods Data were obtained from the 2024 Korea National Health and Nutrition Examination Survey, the most recent dataset released in December 2025. The main analytic sample included 1,551 adults aged 65 years or older. The cumulative biological risk score (CBRS) was calculated using five indicators: anemia, elevated glycated hemoglobin, obesity defined as body mass index ≥ 25 kg/m 2 , elevated high-sensitivity C-reactive protein, and vitamin D deficiency. Hypertension was defined as self-reported physician-diagnosed hypertension. Complex sample analyses incorporated sampling weights, stratification variables, and cluster variables. Complex sample logistic regression was performed using IBM SPSS Statistics version 30.0. Results CBRS showed a graded association with hypertension across risk categories. Compared with the low-risk group, the moderate-risk group had higher odds of hypertension (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.16-2.40), and the high-risk group had still higher odds (OR = 2.92, 95% CI = 1.87-4.54). Age, monthly alcohol use, and absence of aerobic physical activity were also associated with higher odds of hypertension. Conclusion Cumulative biological risk was significantly associated with hypertension among older adults in Korea, suggesting that hypertension in later life may be related to accumulated biological dysregulation. An integrated assessment of multiple biological and metabolic abnormalities may help characterize clustered biological vulnerability and support comprehensive preventive nursing care.

Discussion

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Cite This Study

Hwang et al. (2026) conducted a cross-sectional in Hypertension (n=1,551). High cumulative biological risk score (CBRS ≥ 3) vs. Low cumulative biological risk score (CBRS = 0) was evaluated on Hypertension (self-reported physician-diagnosed) (OR 2.92, 95% CI 1.87-4.54, p=<0.001). A high cumulative biological risk score was significantly associated with nearly three times higher odds of hypertension (OR 2.92) compared to a low-risk score among older adults in Korea.

synapsesocial.com/papers/6a916fcfd15324a1df3aa8b3 https://doi.org/10.7586/jkbns.26.026

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Association between cumulative biological risk and hypertension in older adults in Korea: a population-based cross-sectional study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between cumulative biological risk and hypertension in older adults in Korea: a population-based cross-sectional study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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