Hypertension is a major global health concern and a leading contributor to cardiovascular morbidity and mortality (1). The World Health Organization (WHO) estimates that over 1.28 billion adults aged 30–79 years worldwide are affected by hypertension, with the majority residing in low- and middle-income countries (2). Obesity, particularly central obesity, is one of the most important modifiable risk factors for the development of high blood pressure (3).

Traditional anthropometric indicators like Body Mass Index (BMI) are widely used to assess general adiposity. However, BMI fails to distinguish between fat and lean mass and does not account for fat distribution, which is more relevant to cardiovascular risk (4). Consequently, measures such as Waist-Hip Ratio (WHR) and Waist-Height Ratio (WHtR) have been proposed as better indicators of central adiposity and cardiometabolic risk (5,6).

Recent evidence suggests that WHtR may be a more reliable predictor of hypertension than BMI or WHR, particularly in middle-aged individuals who experience significant changes in body composition and fat distribution (7). However, findings remain inconsistent across populations, and further evaluation is warranted to determine the most suitable anthropometric index for predicting hypertension risk in this demographic.

This study aims to compare the effectiveness of BMI, WHR, and WHtR as predictors of hypertension among middle-aged individuals and identify the most accurate index for early detection.

A total of 300 middle-aged adults, aged between 40 and 60 years, were included in the study using a simple random sampling technique. Participants with a history of secondary hypertension, chronic kidney disease, pregnancy, or those on antihypertensive medications for secondary causes were excluded.

Anthropometric Measurements

Height was measured without shoes using a wall-mounted stadiometer and recorded to the nearest 0.1 cm. Body weight was measured using a digital scale, ensuring minimal clothing and no footwear. BMI was calculated using the standard formula: weight in kilograms divided by the square of height in meters (kg/m²). Waist circumference was measured midway between the lower margin of the last palpable rib and the top of the iliac crest. Hip circumference was measured at the level of the widest portion of the buttocks. Waist-Hip Ratio (WHR) and Waist-Height Ratio (WHtR) were derived using standard formulae.

Blood Pressure Measurement

Blood pressure was measured using a calibrated digital sphygmomanometer. Two readings were taken at five-minute intervals in a seated position after a rest period of 10 minutes. The average of the two readings was used. Hypertension was defined according to the JNC 8 guidelines as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg.

Statistical Analysis

Data were analyzed using SPSS version 25. Descriptive statistics were applied for baseline characteristics. Receiver Operating Characteristic (ROC) curves were generated to assess the predictive accuracy of BMI, WHR, and WHtR in relation to hypertension. The area under the curve (AUC), sensitivity, and specificity values were used to compare the performance of these indices. A p-value of less than 0.05 was considered statistically significant.

A total of 300 middle-aged participants (150 males and 150 females) were included in the study. The overall mean age was 49.8 ± 6.1 years. Of the total population, 165 individuals (55%) were classified as hypertensive based on JNC 8 criteria.

Table 1 shows the baseline anthropometric and blood pressure characteristics of the participants. The mean BMI of the total sample was 27.3 ± 4.5 kg/m², while the average WHR and WHtR were 0.92 ± 0.08 and 0.57 ± 0.05, respectively.

Table 1. Baseline characteristics of study participants (n = 300)

Among the hypertensive group (n = 165), the mean WHtR was significantly higher (0.61 ± 0.04) compared to the normotensive group (0.52 ± 0.03, p < 0.001), indicating a strong association between central adiposity and elevated blood pressure. Similarly, WHR was elevated in the hypertensive group (0.96 ± 0.07) versus the normotensive group (0.88 ± 0.06, p < 0.01), while the difference in BMI was comparatively less pronounced (28.4 ± 4.3 vs. 25.8 ± 4.0, p = 0.045).

Table 2. ROC analysis of anthropometric indices in predicting hypertension

As illustrated in Table 2, WHtR demonstrated the highest predictive accuracy for hypertension with an AUC of 0.82, followed by WHR (AUC = 0.76) and BMI (AUC = 0.71). The sensitivity and specificity values were also highest for WHtR at the identified cut-off of ≥0.55.

These findings suggest that WHtR is a superior anthropometric indicator for predicting hypertension in middle-aged individuals, as compared to BMI and WHR (Table 2).

This study aimed to compare the predictive ability of three commonly used anthropometric indices—Body Mass Index (BMI), Waist-Hip Ratio (WHR), and Waist-Height Ratio (WHtR)—in identifying hypertension among middle-aged individuals. The findings revealed that WHtR was the most effective indicator, showing a higher area under the curve (AUC) and better sensitivity and specificity compared to BMI and WHR.

BMI has long been considered a standard tool for assessing general obesity and its association with cardiovascular diseases (1). However, it fails to account for fat distribution and cannot distinguish between fat mass and lean body mass (2,3). Our findings showed a modest association between elevated BMI and hypertension, consistent with previous research that questions its standalone utility in cardiovascular risk prediction (4).

In contrast, WHR and WHtR, both measures of central adiposity, showed stronger correlations with elevated blood pressure. Central obesity is known to be more closely associated with insulin resistance, endothelial dysfunction, and sympathetic overactivity, all of which contribute to hypertension (5,6). The superiority of WHtR observed in this study supports similar findings reported in various population-based studies (7–9).

WHtR has gained increasing attention as a reliable screening tool because it accounts for stature differences and better reflects visceral fat accumulation (10). Our study identified an optimal WHtR cut-off of 0.55 for predicting hypertension, closely aligning with previous recommendations that propose 0.5 as a global boundary value for increased cardiovascular risk (11,12). The high sensitivity and specificity of WHtR in our sample suggest that it may be a more practical and accurate indicator for early identification of individuals at risk.

Several studies from different regions have confirmed the strong predictive value of WHtR over BMI and WHR for hypertension and other metabolic disorders (13,14). A meta-analysis by Ashwell et al. concluded that WHtR outperforms BMI and WHR in detecting cardiometabolic risk factors across ethnic groups (15). Moreover, WHtR is simple to measure and interpret, requiring only a tape measure and a basic understanding of the individual's height, which enhances its utility in community and primary care settings.

However, certain limitations should be acknowledged. This study was cross-sectional in nature, limiting the ability to infer causality. Additionally, confounding factors such as dietary habits, physical activity, and genetic predisposition were not extensively evaluated. Further longitudinal studies are needed to validate WHtR as a predictive tool for hypertension and to explore its implications in different age and ethnic groups.

In conclusion, our findings reinforce the clinical utility of WHtR as a superior anthropometric index for predicting hypertension among middle-aged individuals. It may serve as an accessible, low-cost, and reliable screening measure, particularly in resource-limited settings, and could be incorporated into public health strategies aimed at early detection and prevention of cardiovascular diseases.

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