Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 1;15(1):4007.
doi: 10.1038/s41598-025-87029-0.

Association between cardiometabolic index and hypertension among US adults from NHANES 1999-2020

Tuo Guo  1   2 , Yang Zhou  3   4 , Guifang Yang  1   2 , Lijuan Sheng  5 , Xiangping Chai  6   7   8
Affiliations

Association between cardiometabolic index and hypertension among US adults from NHANES 1999-2020

Tuo Guo et al. Sci Rep. .

Abstract

Hypertension, a major global health issue and leading cause of death, is often under-assessed by traditional metrics like Body Mass Index which fail to capture comprehensive cardiovascular risks associated with obesity. The Cardiometabolic Index (CMI), which evaluates abdominal obesity and dyslipidemia, offers a more accurate assessment of visceral fat and metabolic dysfunction. In this study, we analyzed data from 45,250 participants from the National Health and Nutrition Examination Survey spanning 1999 to 2020. Using multivariable logistic regression, we explored the association between CMI and hypertension, employing Restricted Cubic Spline analysis to assess non-linear relationships and two-piecewise linear regression to identify threshold effects. Subgroup analyses confirmed the consistency of our findings across various demographic and clinical characteristics. Findings confirmed that hypertensive participants exhibited significantly higher CMI levels (median 0.46 vs. 0.73), with adjusted logistic regression showing a notable association between increased CMI and hypertension prevalence (OR 1.30, 95% CI 1.25-1.35, P < 0.01), characterized by a nonlinear L-shaped curve with a critical threshold identified at a CMI value of 1.37. Subgroup analysis revealed a more pronounced impact of CMI on hypertension in females. These results underscore CMI's potential to enhance cardiovascular risk assessment across diverse U.S. populations.

Keywords: Cardiometabolic index; Hypertension; Metabolic dysfunction; NHANES; Visceral adiposity.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The ethics review board of the National Center for Health Statistics approved all NHANES protocols, and written informed consents were obtained from all participants or their proxies. All the experiment protocol for involving humans was in accordance to guidelines of national/international/institutional or Declaration of Helsinki in the manuscript.

Figures

Fig. 1
Fig. 1
Flow chart of study participants selection.
Fig. 2
Fig. 2
Association between CMI and hypertension performed by restricted cubic spline analysis. Red lines represent the odds ratio, and red transparent areas represent the 95% confidence intervals. The results are weighted based on the survey. OR odds ratio, CI confidence interval, CMI cardiometabolic index.
Fig. 3
Fig. 3
Association between CMI and hypertension in various subgroups. Results are expressed as multivariable-adjusted odds ratio after controlling covariates that include age, sex, race, marital status, educational level, smoking status, TC, and history of diabetes mellitus, CVD, and CKD, except for the variable used in each specific subgroup analysis, which was not adjusted for in its own analysis. The results are weighted based on the survey. OR odds ratio, CI confidence interval, Ref reference, CMI cardiometabolic index, TC total cholesterol, CVD cardiovascular disease, CKD chronic kidney disease.
See this image and copyright information in PMC

References

    1. World Health Organization. Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension (2023).
    1. Olsen, M. H. et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet388, 2665–2712. 10.1016/s0140-6736(16)31134-5 (2016). - DOI - PubMed
    1. Mills, K. T. et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation134, 441–450. 10.1161/circulationaha.115.018912 (2016). - DOI - PMC - PubMed
    1. Bundy, J. D. et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol.2, 775–781. 10.1001/jamacardio.2017.1421 (2017). - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html (2023).

LinkOut - more resources