Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a lipid-based marker of hypertension: a large-scale cross-sectional investigation
- 1Department of Internal Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009 China
Abstract
Background: Dyslipidemia is a known contributor to hypertension, yet the utility of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) for hypertension assessment remains unclear. We examined whether the NHHR is associated with hypertension and whether this association varies by demographic and metabolic characteristics.
Methods: This cross-sectional study included 10,735 adults who underwent health examinations. Participants were grouped by NHHR quartiles. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the association between NHHR and hypertension.
Results: Hypertension was present in 32.8% of participants. Each one-unit increase in NHHR was not significantly associated with hypertension in the unadjusted model (PR 0.99, 95% CI 0.96–1.03, P = 0.735). After adjustment for age, sex, and eGFR, the association became significant (PR 1.09, 95% CI 1.05–1.12, P < 0.001), with participants in the highest quartile having 24% higher prevalence compared with the lowest (PR 1.24, 95% CI 1.13–1.37, P < 0.001). However, after additional adjustment for BMI, the association was substantially attenuated (PR 1.03, 95% CI 1.00–1.07, P = 0.068). These findings were robust across sensitivity analyses.
Conclusions: An elevated NHHR was associated with hypertension after adjustment for demographic factors, but this association was substantially attenuated by BMI, suggesting that adiposity largely accounts for the observed relationship. The NHHR may serve as a convenient lipid-related marker, but its clinical utility for screening requires further investigation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06420-5.
Related
- Association between the uric acid to high‑density lipoprotein cholesterol ratio and H‑type hypertension: a cross‑sectional study in Chinese adults.
- Association between the fasting blood glucose to high-density lipoprotein cholesterol ratio and non-alcoholic fatty liver disease in Chinese adults: a secondary analysis
- Small dense low-density lipoprotein cholesterol and risk of cardiovascular events in general adults: a systematic review and meta-analysis of prospective studies.
- Association of the triglyceride-to-high-density lipoprotein cholesterol ratio with kidney stone status: cross-sectional and machine-learning analyses
- Joint association of the cholesterol–high-density lipoprotein–glucose index and waist-to-height ratio with incident cardiovascular disease in a high-risk Chinese cohort
BibTeX
@article{hong2026nonhighdensity,
title = {{Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a lipid-based marker of hypertension: a large-scale cross-sectional investigation}},
author = {Yilian Hong and QingPing Zhang and Wen Xu},
journal = {BMC Cardiovascular Disorders},
year = {2026},
month = aug,
doi = {10.1186/s12872-026-06420-5},
url = {https://doi.org/10.1186/s12872-026-06420-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio as a lipid-based marker of hypertension: a large-scale cross-sectional investigation
AU - Yilian Hong
AU - QingPing Zhang
AU - Wen Xu
PY - 2026
DA - 2026/08/08
JO - BMC Cardiovascular Disorders
DO - 10.1186/s12872-026-06420-5
UR - https://doi.org/10.1186/s12872-026-06420-5
AB - Background: Dyslipidemia is a known contributor to hypertension, yet the utility of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) for hypertension assessment remains unclear. We examined whether the NHHR is associated with hypertension and whether this association varies by demographic and metabolic characteristics. Methods: This cross-sectional study included 10,735 adults who underwent health examinations. Participants were grouped by NHHR quartiles. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the association between NHHR and hypertension. Results: Hypertension was present in 32.8% of participants. Each one-unit increase in NHHR was not significantly associated with hypertension in the unadjusted model (PR 0.99, 95% CI 0.96–1.03, P = 0.735). After adjustment for age, sex, and eGFR, the association became significant (PR 1.09, 95% CI 1.05–1.12, P < 0.001), with participants in the highest quartile having 24% higher prevalence compared with the lowest (PR 1.24, 95% CI 1.13–1.37, P < 0.001). However, after additional adjustment for BMI, the association was substantially attenuated (PR 1.03, 95% CI 1.00–1.07, P = 0.068). These findings were robust across sensitivity analyses. Conclusions: An elevated NHHR was associated with hypertension after adjustment for demographic factors, but this association was substantially attenuated by BMI, suggesting that adiposity largely accounts for the observed relationship. The NHHR may serve as a convenient lipid-related marker, but its clinical utility for screening requires further investigation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06420-5.
SN - 1471-2261
ER -