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Association between hemoglobin A1c to HDL cholesterol ratio and hypertension in middle-aged and older Chinese adults:

Wenqing Si1, Weicheng Lai2, Liangxiu Wu3

  • 1Department of Cardiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China.

BMC Cardiovascular Disorders
|June 26, 2026
PubMed

Insights

The hemoglobin A1c to high-density lipoprotein cholesterol ratio (HHR) is linked to a higher prevalence of hypertension in older Chinese adults. This association appears to be nonlinear, suggesting a complex relationship between glycemic control, lipid metabolism, and blood pressure.

Area of Science:

  • Cardiovascular Health
  • Metabolic Syndrome
  • Public Health

Background:

  • The hemoglobin A1c to high-density lipoprotein cholesterol ratio (HHR) is a novel composite index.
  • HHR reflects both chronic glycemic exposure and lipid metabolism.
  • The association between HHR and hypertension is not well understood.

Purpose of the Study:

  • To investigate the independent association between HHR and hypertension prevalence.
  • Study focused on middle-aged and older Chinese adults.

Main Methods:

  • Cross-sectional study using China Health and Retirement Longitudinal Study (CHARLS) data (2011, 2015).
  • Included 11,797 participants after applying inclusion/exclusion criteria.
  • Utilized multivariable logistic regression and restricted cubic spline analyses, adjusting for confounders.

Main Results:

  • HHR was positively associated with hypertension prevalence.
  • Each 0.1-unit increase in HHR correlated with higher odds of hypertension (OR=1.02).
  • High HHR group showed significantly higher odds of hypertension (OR=1.38) compared to the low HHR group; a nonlinear association was observed.

Conclusions:

  • Elevated HHR is associated with hypertension in a nonlinear pattern in middle-aged and older Chinese adults.
  • Findings indicate association, not causality, due to the cross-sectional design.
  • Further prospective studies are needed to assess HHR's incremental value in hypertension risk assessment.
Abstract

Keywords:
CHARLSHbA1c/HDL-C ratioHypertensionPrevalence

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