Effect of Hypertension, Waist-to-Height Ratio, and Their Transitions on the Risk of Type 2 Diabetes Mellitus: Analysis from the China Health and Retirement Longitudinal Study

Abstract

Background: Diabetes is a major reason of death and disability worldwide and frequently coexists with hypertension and central obesity. This study is aimed at investigating the effects of hypertension, waist-to-height ratio (WHtR), and their dynamic transitions on type 2 diabetes mellitus (T2DM) onset among middle-aged and elderly people in China.

Methods: We analyzed 9843 participants free of T2DM (average age, 59.04 ± 9.26 years) at baseline from the China Health and Retirement Longitudinal Study. We classified the participants into the following four categories based on hypertension and WHtR statuses: nonhypertensive with a normal WHtR (NHNW); hypertensive with a normal WHtR (HTNW); nonhypertensive with an elevated WHtR (NHEW); and hypertensive with an elevated WHtR (HTEW). By using a Cox proportional hazards regression model, we assessed whether hypertension, WHtR, and their transitions over time correlated with T2DM risk.

Results: During the follow-up of 8 years, 1263 participants developed incident T2DM. The hazard ratio (HR) for T2DM was 1.48 (95% CI: 1.12, 1.97), 1.56 (95% CI: 1.27, 1.92), and 2.15 (95% CI: 1.74, 2.67) in the HTNW, NHEW, and HTEW groups, respectively, compared with the NHNW group after controlling for confounding factors. When stratified by statuses of hypertension and WHtR transitions, the participants who transitioned from HTNW to HTEW (HR = 1.98, 95% CI: 1.24-3.17), or NHEW to NHNW/HTNW (HR = 1.74, 95% CI: 1.14-2.65), or remained NHEW (HR = 1.42, 95% CI: 1.04-1.93), or NHEW to HTEW (HR = 2.40, 95% CI: 1.66-3.49), or remained HTEW (HR = 2.51, 95% CI: 1.87-3.37) during the follow-up period showed a higher T2DM risk than the consistently NHNW participants.

Conclusions: Being HTNW, NHEW or HTEW or occurring adverse transitions between those states was strongly associated with T2DM onset. Effectively warding off hypertension and central obesity or preventing their further aggravation may substantially decrease the T2DM risk.

Figure 1

Flowchart of selecting study participants.

Figure 2

Cumulative Incidence of T2DM according to the four categories of hypertension and WHtR statuses and gender, CHARLS, 2011–2018. Note: NHNW: nonhypertensive with a normal WHtR; HTNW: hypertensive with a normal WHtR; NHEW: nonhypertensive with an elevated WHtR; HTEW: hypertensive with an elevated WHtR.

Figure 3

Association of T2DM with hypertension and WHtR transitions in CHARLS 2011–2018. Note: the model was adjusted for age, hukou, residence, education, marital status, self-reported health, BMI, smoking, alcohol consumption, and dyslipidemia. HR: hazard ratio; CI: confidence interval. Subgroup I, stable NHNW; subgroup II, transition from NHNW to HTNW; subgroup III, from NHNW to NHEW; subgroup IV, from NHNW to HTEW; subgroup V, stable HTNW; subgroup VI, from HTNW to HTEW; subgroup VII, from NHEW to NHNW/HTNW; subgroup VIII, stable NHEW; subgroup IX, from NHEW to HTEW; subgroup X, from HTEW to HTNW; subgroup XI, stable HTEW. Subgroup I served as the reference group.