Ratio of waist circumference to body mass index: A novel predictor of clinical outcome in hypertension patients

• Published in: The journal of clinical hypertension (Greenwich, Conn.) Vol. 26; no. 1; pp. 24 - 35
• Main Authors: Wang, Yi‐Han, Hua, Yang, Zhang, Heng‐Zhi, Liang, Shuo, Cao, Ze‐Zhong, Chen, Lu‐Lu, Su, Zhen‐Yang, Zhang, Wei
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-01-2024; John Wiley and Sons Inc; Wiley
• Subjects: Abdomen; Age; Alcohol; all‐cause mortality; Antihypertensives; Blood pressure; Body Mass Index; body mass index (BMI); Cardiovascular disease; Cardiovascular Diseases; cardiovascular‐specific death; Cholesterol; Diabetes; Exercise; Family income; Glucose; Heart failure; High density lipoprotein; Humans; Hypertension; Hypertension - complications; Hypertension - diagnosis; Hypertension - epidemiology; Kidney diseases; Mortality; Nutrition; Obesity; Obesity - complications; Obesity - epidemiology; Original; Population; Poverty; Prospective Studies; Risk Factors; Self report; Smoking; Variables; Waist Circumference; waist circumference‐to‐BMI ratio; waist circumference; waist circumference-to-BMI ratio; all-cause mortality; body mass index (BMI); cardiovascular-specific death
• ISSN: 1524-6175; 1751-7176
• DOI: 10.1111/jch.14739

We aim to investigate the influence of waist circumference and body mass index (BMI) on all‐cause death and cardiovascular‐specific death in patients with hypertension. This prospective cohort study, based on waist circumference and body mass index measurements in patients with hypertension, provided risk estimates of all‐cause mortality and cardiovascular events. The waist circumference‐to‐BMI ratio (WtBR) is an anthropometric measure integrating waist circumference and BMI. We utilized multivariable Cox regression analysis, restricted cubic spline model, Kaplan‐Meier plot, random forest analysis, and sensitivity analysis to assess the relationship of WtBR with all‐cause mortality. Subsequently, Fine‐Gray competing risk regression models were applied to precisely evaluate the probability of cardiovascular‐specific death attributed to high WtBR. The results indicate that thea deceased group showed significantly higher WtBR and lower BMI compared with the alive groups (P < .05), while no significant difference was observed in waist circumference (P = .373). When analyzed as continuous, the risk of all‐cause death elevated with increasing WtBR in the adjusted model with an HR of 2.42 (95% CI, 2.06‐2.85). The restricted cubic spline illustrated an elevated risk of all‐cause mortality as WtBR increased (J‐shaped curve). Nevertheless, WtBR showed no significant association with cardiovascular‐specific death and the prediction model exhibited a reliable performance in the testing set. This study supported that WtBR, an anthropometric measure, is independently associated with all‐cause death in hypertensive patients. It's advisable to routinely assess waist circumference in hypertensive patients regardless of BMI, in order to more effectively manage the risk of obesity‐related health.