Associations of Arm‐to‐Waist Ratio With Hypertension and Blood Pressure: The Role of Peripheral‐Central Body Size Distribution in U.S. Individuals

Q: What are the key findings of this study?

Each 1% increment in arm-to-waist ratio was independently associated with a 3% lower odds of hypertension in U.S. adults.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: General population (n=50656). Intervention: Arm-to-waist ratio (AWR). Primary outcome: Hypertension (self-reported physician diagnosis) (OR 0.97, 95% CI 0.96-0.97, p=<0.001).

Q: What does this research mean for the field?

Arm-to-waist ratio is independently and inversely associated with blood pressure and hypertension in U.S. adults, with each 1% increase associated with a 3% lower odds of hypertension. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

To investigate the associations of arm-to-waist ratio (AWR)—a metric reflecting peripheral-central body size distribution—with hypertension and blood pressure.

Fang Zhang; Zhanyang Zhou; Jian Zhang; Yuqing Zhang

doi:10.1111/jch.70354

September 1, 2026Journal of Clinical HypertensionOpen Access

Associations of Arm‐to‐Waist Ratio With Hypertension and Blood Pressure: The Role of Peripheral‐Central Body Size Distribution in U.S. Individuals

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Key result

Higher arm-to-waist ratio linked to ~3% lower hypertension odds per 1% increment.

OR 0.97
95% CI 0.96-0.97
P<0.001
n=50,656

Figures

Why the study?

The role of peripheral-central body size distribution, as reflected by arm-to-waist ratio, in hypertension and blood pressure was not well understood in U.S. individuals.

Key Points

To investigate the associations of arm-to-waist ratio (AWR)—a metric reflecting peripheral-central body size distribution—with hypertension and blood pressure.
Included 50,656 participants from the National Health and Nutrition Examination Survey (NHANES 1999–2018).
Assessed Pearson correlations among anthropometric indices and blood pressure, and performed multivariable logistic regression for hypertension and linear regression for systolic and diastolic blood pressure.
Hypertension prevalence decreased across increasing quartiles of AWR from 47.5% in Q1 to 32.2% in Q2, 23.6% in Q3, and 16.9% in Q4 (P for trend < 0.001).
Each 1% increment in AWR was associated with lower odds of hypertension (adjusted OR 0.97, 95% CI 0.96–0.97; P < 0.001), whereas BMI, WC, WHtR, and AC were positively associated with hypertension (all P < 0.001).
Among individuals without prior hypertension, higher AWR was independently associated with lower systolic blood pressure (r = -0.19, P < 0.001) and diastolic blood pressure (r = -0.08, P < 0.001).

Study Design

Type

Cross-Sectional (n=50,656)

Structured PICO

P

Population

50,656 U.S. adults aged 16 and older from the NHANES 1999-2018 cohort, evaluated to assess the association of arm-to-waist ratio with hypertension.

E

Exposure

Higher arm-to-waist ratio (AWR) (exposure)

C

Comparator

Lower arm-to-waist ratio (AWR) (exposure)

O

Outcome

Prevalence of hypertension (self-reported physician diagnosis) and systolic/diastolic blood pressure levelssurrogate

Main Result

Odds Ratio: 0.97 (95% CI 0.96–0.97)

p-value: p=<0.001

The arm-to-waist ratio (AWR) represents a simple anthropometric index that is inversely and independently associated with hypertension, offering insight into cardiovascular risk beyond conventional markers of general and central adiposity like BMI and waist circumference.

Limitations

Hypertension ascertained by self-reported physician diagnosis
AWR is an indirect anthropometric measure and cannot distinguish skeletal muscle mass from subcutaneous adipose tissue
Residual confounding and selection bias cannot be completely excluded
Cross-sectional design precludes establishing causal relationships
Survey sampling weights were not incorporated in the analyses
Hypertension was ascertained by self-reported physician diagnosis, which may be subject to recall bias and does not capture undiagnosed hypertension.
AWR is an indirect anthropometric measure and cannot distinguish skeletal muscle mass from subcutaneous adipose tissue.
Residual confounding and selection bias resulting from complete-case analysis cannot be completely excluded.
Cross-sectional design of NHANES cannot establish causal relationships.
Survey sampling weights were not incorporated in the analyses.

Implication

Does not support clinical use of arm-to-waist ratio for hypertension risk; leaves open its incremental prognostic value in prospective cohorts.

Abstract

The arm-to-waist ratio (AWR) reflects peripheral-central body size distribution. This study investigated the associations of AWR with hypertension and blood pressure. A total of 50,656 participants from NHANES 1999-2018 were included. Pearson correlation analyses were performed to evaluate the correlations among anthropometric indices and blood pressure. We utilized multivariable logistic regression for hypertension and linear regression for systolic and diastolic blood pressure (SBP and DBP). Overall, 15,211 (30%) individuals had hypertension. The prevalence of hypertension decreased progressively across increasing quartiles of AWR (47.5%, 32.2%, 23.6%, and 16.9%, respectively; P for trend < 0.001). AWR was correlated with BMI (r = -0.16), WC (r = -0.41), WHtR (r = -0.46), and AC (r = 0.16; all P < 0.001). Each 1% increment in AWR was associated with lower odds of hypertension (adjusted odds ratio [OR] 0.97, 95% CI 0.96-0.97; P < 0.001), whereas BMI, WC, WHtR, and AC were all positively associated with hypertension (all P < 0.001). Significant interactions were observed between AWR and both age and sex (both P for interaction < 0.001). After multivariable adjustment, nonlinear associations were observed between AWR and hypertension (men: P for overall < 0.001, P for nonlinearity < 0.001; women: P for overall = 0.051, P for nonlinearity = 0.021). Among those without prior hypertension, increased AWR was independently associated with lower SBP and DBP (both P < 0.001). AWR is independently and inversely associated with hypertension and blood pressure in U.S. individuals, exhibiting notable sex differences. Our study highlights the potential importance of peripheral-central body size distribution in hypertension development.

Discussion

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Cite This Study

Zhang et al. (2026) conducted a cross-sectional in General population (n=50,656). Arm-to-waist ratio (AWR) was evaluated on Hypertension (self-reported physician diagnosis) (OR 0.97, 95% CI 0.96-0.97, p=<0.001). Each 1% increment in arm-to-waist ratio was independently associated with a 3% lower odds of hypertension in U.S. adults.

synapsesocial.com/papers/6ad0fcf33afa093ea9ad00ca https://doi.org/10.1111/jch.70354

Topics

Hypertension management

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Associations of Arm‐to‐Waist Ratio With Hypertension and Blood Pressure: The Role of Peripheral‐Central Body Size Distribution in U.S. Individuals

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Associations of Arm‐to‐Waist Ratio With Hypertension and Blood Pressure: The Role of Peripheral‐Central Body Size Distribution in U.S. Individuals

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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