Impact of the American Heart Association/American College of Cardiology Blood Pressure Classification on Insulin...

The 2025 American Heart Association (AHA)/American College of Cardiology (ACC) blood pressure (BP) guidelines modified diagnostic thresholds, expanding the population classified as hypertensive and enabling earlier identification of individuals with subclinical metabolic dysfunction.

To evaluate whether insulin resistance (IR), assessed using the triglyceride-glucose (TyG) index -a validated surrogate marker of IR- differs across the 2025 AHA/ACC BP categories in adults previously considered normotensive according to the Eighth Joint National Committee (JNC-8) definition.

We conducted a cross-sectional analysis of 3,235 clinically healthy adults (age 37 ± 9 years; 63% women) with BP <140/90 mmHg and fasting glucose ≤125 mg/dL. BP was categorized as normal (<120/80 mmHg), elevated (120-129/<80 mmHg), or stage 1 hypertension (130-139/80-89 mmHg) according to the 2025 AHA/ACC criteria.

Reclassification identified 2,469 (76.3%) individuals with normal BP, 123 (3.8%) with elevated BP, and 643 (19.9%) with stage 1 hypertension. Mean TyG values increased progressively across BP categories (4.64 ± 0.27; 4.76 ± 0.27; 4.80 ± 0.28, respectively; p <0.001). Correspondingly, IR prevalence rose from 41% to 63% and 64% (p <0.001). IR prevalence was more pronounced in men than in women. Associations between BP categories and both TyG values and IR persisted after multivariate adjustment.

Among clinically healthy adults, the 2025 AHA/ACC BP thresholds identify subgroups with substantially higher metabolic burden. Incremental increases in BP, previously considered within normal ranges according to JNC-8 criteria, are associated with IR.