Nonlinear Associations and Gender Disparities Between Cardiometabolic Index and Hypertension in Chinese Adults

The present study aimed to evaluate the relationship between cardiometabolic index (CMI) and hypertension. We undertook a cross-sectional study with a sample of 9013 adults from China. The cardiometabolic index is computed as a product of WHtR and triglyceride-to-HDL cholesterol ratio (TG/HDL ratio). Logistic regression analysis was used to evaluate the association between the CMI and hypertension. Restricted cubic spline (RCS) analysis demonstrated a nonlinear relationship between the CMI and hypertension. The predictive capability of CMI was evaluated using ROC curve analysis. Participants in the highest CMI quartile (Q4) exhibited a 1.34-fold increased risk of hypertension compared to those in the lowest quartile (Q1). Notably, females with CMI > 0.36 exhibited a 52% higher hypertension risk (OR = 1.52, 95% CI:1.15–1.99). Gender-specific analyses revealed that the association was attenuated in males after full adjustment for covariates, suggesting a stronger link between CMI and hypertension risk in females. Restricted cubic spine (RCS) analysis showed a nonlinear relationship, with hypertension risk accelerating beyond a CMI threshold of 0.36. The predictive performance of CMI yielded an AUC of 0.667, indicating moderate discriminatory ability. The study underscores the importance of metabolic health in hypertension pathogenesis and suggests that CMI may serve as a useful marker for early intervention and risk stratification in clinical practice. Further studies are warranted to validate these findings and elucidate the underlying mechanisms.