Association of Hypertension With Telomere Length, Considering Non-Genetic and Genetic Factors, in Middle-Aged Koreans

Leukocyte telomere length (LTL) has been associated with hypertension. However, this association remains unclear in middle-aged populations. This study aimed to investigate the association between LTL and hypertension in middle-aged Koreans, considering genetic and non-genetic factors. We used baseline data from middle-aged participants (aged 30-55 years) in the Korean Medicine Daejeon Citizen Cohort. LTL was measured in 1914 participants using quantitative polymerase chain reaction. We calculated the genome-wide association study-based polygenic risk score (PRS) for telomere length. Multivariable regression analysis was conducted to examine the association between LTL and hypertension and to explore this association based on non-genetic and genetic factors. After adjusting most variables (Model 1), individuals in the highest LTL quartile showed an inverse association with hypertension compared to those in the lowest quartile (odds ratio [OR] = 0.60, 95% confidence interval [CI] 0.41-0.86). When further adjusted for antihypertensive medication (Model 2), the association remained but was borderline (OR = 0.66, 95% CI = 0.42-1.04). This inverse association was more clearly observed in stratified subgroups of younger individuals (<45 years), those with optimal low-density lipoprotein cholesterol levels (<130 mg/dL), and those with adequate sleep duration (≥ 6 h). Hypertension showed a weak association with PRS; there was no significant relationship between PRS and age. Our findings suggest that LTL is independently associated with hypertension in middle-aged populations; this association varied according to non-genetic factors. These results demonstrate the potential of using LTL as a measure for hypertension screening and for the development of personalized intervention strategies in healthy populations.