Is Waist-to-Height Ratio Superior to Body Mass Index and Waist Circumference in Predicting the Incidence of Hypertension?

Abstract

Background: It is still controversial which anthropometric indicator could be the best predictor of the incident hypertension. Objectives: To examine the relative power of body mass index (BMI), waist circumference (WC), skinfold thickness, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) in predicting the incidence of hypertension in Chinese adults. Method: Data were obtained from the China Health and Nutrition Survey. Overweight was defined as BMI ≥23 kg/m² and general obesity as BMI ≥27.5 kg/m². Abdominal obesity was defined by WC values ≥90 cm for males and ≥80 cm for females. Skinfold thickness, WHR, and WHTR were divided into low and high groups according to receiver operating characteristics. Cox regressions and nomograms were employed to compare the relative power of 5 indicators in predicting incident hypertension. Results: When all indicators were analyzed simultaneously, the best predictor of incident hypertension was general obesity (p < 0.001, adjusted hazard ratio [HR] 1.9, 95% CI 1.6–2.2). The results stratified by sex showed that BMI and WC were the more powerful predictors of hypertension in males (adjusted HR 1.8 and 1.3, 95% CI 1.4–2.3 and 1.1–1.5, respectively) as well as in females (adjusted HR 2.0 and 1.4, 95% CI 1.6–2.4 and 1.2–1.6, respectively). Conclusions: BMI and WC may predict incident hypertension better than skinfold thickness, WHR, and WHTR in the Chinese population.