The triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C) ratio is considered a simple surrogate of insulin resistance. The aim of this study was to explore the association of the TG/HDL-C ratio with the risk of incident hypertension and whether the TG/HDL-C ratio mediates the obesity-incident hypertension association. The study analyzed 9679 participants from a rural Chinese population. Demographic and anthropometric and laboratory data were collected at baseline (2007-2008) and follow-up (2013-2014) examinations. A multivariate logistic regression model was used to analyze the association of the TG/HDL-C ratio with incident hypertension, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was performed to examine the contribution of the TG/HDL-C ratio to obesity-related incident hypertension. During a median follow-up of 6.00 years, hypertension developed in 1880/9679 participants (19.42%). The risk of incident hypertension was higher in the highest TG/HDL-C ratio quartile than in the lowest quartile (OR = 1.21, 95% CI = 1.02-1.42). Subgroup analyses showed that the risk of incident hypertension was increased by 30%, 36%, and 33% among women, participants < 60 years old and those with prehypertension at baseline, respectively. The TG/HDL-C ratio partially mediated the obesity-incident hypertension association (indirect effect: OR = 1.04, 95% CI: 1.01-1.07; direct effect: OR = 1.36, 95% CI: 1.16-1.62). The TG/HDL-C ratio may be a risk factor for incident hypertension, especially in women, participants < 60 years old and those with prehypertension. The TG/HDL-C ratio may also play a mediating role in obesity-related incident hypertension.
Keywords: High-density lipoprotein cholesterol; Hypertension; Obesity; Triglycerides.