Associations of Arm-to-Waist Ratio With Hypertension and Blood Pressure: The Role of Peripheral-Central Body Size Distribution in U.S. Individuals.

The arm-to-waist ratio (AWR) reflects peripheral-central body size distribution. This study investigated the associations of AWR with hypertension and blood pressure. A total of 50,656 participants from NHANES 1999-2018 were included. Pearson correlation analyses were performed to evaluate the correlations among anthropometric indices and blood pressure. We utilized multivariable logistic regression for hypertension and linear regression for systolic and diastolic blood pressure (SBP and DBP). Overall, 15,211 (30%) individuals had hypertension. The prevalence of hypertension decreased progressively across increasing quartiles of AWR (47.5%, 32.2%, 23.6%, and 16.9%, respectively; P for trend < 0.001). AWR was correlated with BMI (r = -0.16), WC (r = -0.41), WHtR (r = -0.46), and AC (r = 0.16; all P < 0.001). Each 1% increment in AWR was associated with lower odds of hypertension (adjusted odds ratio [OR] 0.97, 95% CI 0.96-0.97; P < 0.001), whereas BMI, WC, WHtR, and AC were all positively associated with hypertension (all P < 0.001). Significant interactions were observed between AWR and both age and sex (both P for interaction < 0.001). After multivariable adjustment, nonlinear associations were observed between AWR and hypertension (men: P for overall < 0.001, P for nonlinearity < 0.001; women: P for overall = 0.051, P for nonlinearity = 0.021). Among those without prior hypertension, increased AWR was independently associated with lower SBP and DBP (both P < 0.001). AWR is independently and inversely associated with hypertension and blood pressure in U.S. individuals, exhibiting notable sex differences. Our study highlights the potential importance of peripheral-central body size distribution in hypertension development.