Association between atherogenic index of plasma and diabetes with hypertension: results from two nationally representative population-based study

Background The coexistence of hypertension and diabetes imposes a substantial global health burden and significantly elevates the risk of cardiovascular mortality. This study aimed to investigate the relationship between atherogenic index of plasma (AIP) and the comorbidity of hypertension and diabetes. Methods This study analyzed cross-sectional observations obtained from two nationally representative population-based databases (NHANES and CHARLS). Multivariable logistic regression models were employed to assess the association between AIP and the comorbidity of hypertension and diabetes, with extensive adjustment for demographic, lifestyle, and clinical covariates. Mediation analyses were conducted to explore potential pathways. Results This study combined data from two large cohorts, including 13,037 participants from the NHANES dataset and 10,839 participants from the CHARLS dataset. After full adjustment for confounders, a higher AIP was significantly associated with an increased odds of hypertension combined with diabetes in both the NHANES (OR: 3.72, 95% CI: 1.19–11.59) and CHARLS (OR: 3.05, 95% CI: 1.18–7.84) cohorts. A positive dose-response relationship was observed when AIP was analyzed in tertiles. Subgroup analyses showed consistent results across sex, age, smoking, and drinking status. Mediation analyses indicated that BMI, and uric acid partially mediated this association. Conclusion AIP is strongly and independently associated with a higher risk of coexisting hypertension and diabetes, suggesting its value as a simple and integrative biomarker for identifying high-risk individuals. Incorporating AIP into routine clinical assessments could enhance risk stratification and guide targeted preventive strategies for high-risk populations.