A cross-sectional study on the positive association between serum uric acid-to-high-density lipoprotein cholesterol ratio and self-reported physician-diagnosed hypertension with nomogram construction using NHANES and CHARLS data

Hypertension is a highly prevalent cardiovascular disease associated with metabolic and vascular risks. This study aims to explore the association between serum uric acid and the ratio of high-density lipoprotein cholesterol (UHR) and self-reported physician-diagnosed hypertension, and to construct a nomogram for stratifying self-reported physician-diagnosed hypertension. Using a cross-sectional study design, data were obtained from the National Health and Nutrition Examination Survey (NHANES; 1999–2018; n = 16,056) and the China Health and Retirement Longitudinal Study (CHARLS; 2011; n = 10,686). Subsequently, serum uric acid and high‑density lipoprotein cholesterol levels were extracted, and the UHR was calculated. Following this, baseline characteristics were summarized and compared. Furthermore, Extreme Gradient Boosting (XGBoost) was conducted on the full dataset as an exploratory analysis to evaluate the relative feature importance of included variables in association with hypertension status. Then, three hierarchically adjusted logistic regression models were constructed (Model 1: crude model with UHR only; Model 2: additionally adjusted for age, gender, and education level; Model 3: fully adjusted for demographic characteristics, lifestyle factors, comorbidities, and hematological/biochemical indicators) to explore the independent association between UHR and hypertension risk. Additionally, stratified analyses were conducted to assess the stability of the UHR‑hypertension association across subgroups. Finally, a nomogram was established and evaluated. First, baseline analyses revealed that UHR was significantly associated with hypertension in both cohorts. Meanwhile, XGBoost feature importance analysis indicated that UHR exhibited stable and notable relative importance in association with self-reported physician-diagnosed hypertension status in both NHANES and CHARLS datasets. More importantly, multivariate logistic regression with progressive adjustment for a full panel of relevant confounders (demographic characteristics, lifestyle factors, comorbidities, and hematological and biochemical indicators) demonstrated that elevated UHR was independently and positively associated with increased hypertension risk in a graded manner, and the association remained robust after full covariate adjustment. Subsequently, stratified analyses confirmed that the positive association was consistent across most age, history of smoking exposure. Ultimately, the constructed nomogram showed favorable calibration, clinical net benefit, and discriminative performance in both databases. The UHR is an independent and stable factor associated with self-reported physician-diagnosed hypertension risk. The UHR‑integrated nomogram shows acceptable performance in self-reported physician-diagnosed hypertension risk stratification and may have potential utility as a candidate tool for early screening and individualized clinical assessment, pending further prospective validation. Not applicable.