Meta-Analysis and Systematic Review of the Association Between Hypertriglyceridemic Waist Phenotype and Hypertension

Background: The hypertriglyceridemic waist (HTGW) phenotype, defined by elevated waist circumference and triglycerides, is a surrogate marker of visceral adiposity and cardiometabolic dysfunction. While several studies have investigated its association with hypertension, findings have been inconsistent across populations and study designs. Objectives: To systematically evaluate the association between HTGW and hypertension, and to examine whether sex and regional differences influence this relationship. Methods: A systematic search of PubMed, Medline, Embase, Web of Science, ProQuest, CNKI, and Cochrane Library was conducted up to December 2024. Both English and non-English studies were eligible. Grey literature was screened but no additional studies were included. Observational studies reporting odds ratios (ORs) for hypertension by HTGW status in adults were selected. Pooled estimates were calculated using random- or fixed-effects models depending on heterogeneity (I² >50%). Subgroup and sensitivity analyses were performed to explore heterogeneity. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Results: Six studies (n = 32,284; men = 14,102, women = 18,182) were included. The pooled analysis showed that HTGW was significantly associated with hypertension (OR = 1.92; 95% CI: 1.54–2.39; P < 0.001; I² = 35%). Subgroup analyses demonstrated stronger associations in women (OR = 2.05; 95% CI: 1.59–2.64) than men (OR = 1.78; 95% CI: 1.42–2.23), and in Asian populations (OR = 2.04; 95% CI: 1.58–2.63) compared to European cohorts (OR = 1.65; 95% CI: 1.29–2.11). Results were consistent across study design and quality. Sensitivity analyses confirmed robustness, and Egger’s test (P = 0.21) suggested no publication bias, though statistical power was limited. Conclusion: HTGW is significantly associated with nearly twofold higher odds of hypertension, with stronger effects among women and Asian populations. As a simple and inexpensive measure, HTGW may be integrated into hypertension risk prediction models and community screening programs, particularly in resource-limited settings.