Comparison of Hypertension Risk in Elderly Under Adiposity-Based Chronic Disease Model

Background: The Adiposity-Based Chronic Disease (ABCD) model, introduced by the American College of Endocrinology, provides a novel, complication-centric framework for assessing obesity with enhanced pathophysiological relevance. However, its practical value for predicting specific health outcomes, such as hypertension in the elderly, remains largely unexamined in the Chinese population. Objective: This study is anchored in the theoretical framework of ABCD models related to excessive adipose tissue accumulation. Its primary objective is to systematically assess the relationship between various obesity indicators and the risk of hypertension among older adults. Additionally, it aims to compare the predictive efficacy of individual obesity indicators against combined indicators, with the goal of identifying the most effective and stage-specific predictors. Methods: This study focused on elderly individuals aged 65 years or older at a community health service centre in Wuhan City, with a total of 6,784 eligible elderly individuals included in the study. Basic information such as age, gender, family history, smoking, and alcohol consumption was collected for all study participants, along with biochemical indicators such as lipid levels and blood glucose. Obesity was classified into three stages—stage 0, stage 1, and stage 2—using the ABCD model. The performance of the model was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC) values. the efficacy of obesity-related indicators such as the Chinese Visceral Adipose Index (CVAI), Cardiometabolic Index (CMI), Conicity Index (CI), and Body Shape Index (ABSI) in predicting hypertension risk was assessed; the predictive value of single obesity indicators and combined indicators was compared and analysed. Results: This study found that the optimal indicators for predicting hypertension in the elderly vary across different stages of obesity. During the normal stage, the Body Roundness Index (BRI) demonstrated the best predictive performance, with an AUC value of 0.6292. In stages 1 and 2, the Lipid Accumulation Product (LAP) and CMI showed more significant predictive effects, with AUC values of 0.6211 and 0.6243, respectively. Further multi-indicator combined predictive analysis showed that combining multiple obesity-related indicators for prediction can enhance the accuracy of predicting hypertension risk. the AUC value for the combined prediction of WC+AVI in the normal stage was 0.6311, higher than the predictive performance of any single obesity indicator; the AUC value for the combined prediction of WC+BRI in stage 1 reached 0.6354; while the AUC values for the combined predictions of WC+LAP, WC+CI, and WC+CMI in stage 2 were significantly higher than those of single obesity indicators, with the highest AUC value of 0.6478 for WC+LAP, at 0.6478. Conclusions: This study found that as obesity levels change, obesity indicators predicting hypertension in older adults also change, indicating that different prevention and intervention measures should be adopted for different stages of obesity in hypertension management. In addition, the combined use of multiple obesity indicators can improve the predictive ability of hypertension risk in older adults.