Association of cumulative cholesterol-HDL-glucose index with blood pressure changes and risk of new-onset hypertension in middle-aged and older adults: a cohort study

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseases and represents a primary global public health concern. A newer index, the Cholesterol, High-Density Lipoprotein, and Glucose (CHG) index, has been proposed as a novel indicator for diagnosing type 2 diabetes and has recently been demonstrated to predict cardiovascular diseases (CVD). However, the associations of elevated CHG index and its cumulative measures with blood pressure changes and the new-onset hypertension risk in middle-aged and older adults remain unclear. METHODS: Participants from the China Health and Retirement Longitudinal Study (CHARLS) were recruited as the longitudinal cohort for this study, with 2011 as the baseline year and follow-up in 2015. K-means clustering analysis was employed to categorize participants into two groups based on cumulative CHG over the 4-year period. Multivariable logistic regression was used to examine the associations between CHG and cumulative CHG indicators across different groups and the incidence of hypertension, while multivariable linear regression models were applied to assess the relationship between cumulative CHG indicators in different groups and changes in blood pressure. Restricted cubic spline (RCS) regression models were utilized to investigate potential nonlinear associations between cumulative CHG and hypertension events. Receiver operating characteristic (ROC) curves were employed to quantify the predictive performance of CHG and cumulative CHG for incident hypertension. RESULTS: In our study, K-means clustering analysis was employed to categorize participants into two groups based on changes in cumulative CHG. Compared with the first group, where cumulative CHG remained consistently low and stable, the second group exhibited higher baseline mean blood pressure. Furthermore, during the follow-up period, the second group demonstrated significantly greater increases in blood pressure and elevated risk of incident hypertension, with β coefficients of 3.89 (95% CI: 2.23–5.55) for systolic blood pressure and 0.93 (95% CI: 0.35–1.50) for diastolic blood pressure, as well as an odds ratio (OR) of 1.61 (95% CI: 1.26–2.07) for incident hypertension. Similar findings were observed when participants were stratified by cumulative CHG quartiles: compared with the Q1 group, the Q4 group showed higher systolic blood pressure by 4.83 mmHg (95% CI: 2.58–7.08), higher diastolic blood pressure by 1.52 mmHg (95% CI: 0.12–2.93), and a 1.72-fold increased risk of incident hypertension events (95% CI: 1.21–2.43). Unrestricted cubic spline plots revealed a linear association between cumulative CHG and the aforementioned outcomes. ROC curves indicated that the predictive performance of cumulative CHG for incident hypertension was comparable to that of cumulative AIP. Subgroup analyses demonstrated interactions between the cumulative CHG index and CVD or CKD, warranting particular attention to patients with CVD or CKD. CONCLUSIONS: Our findings indicate that an elevated cumulative CHG index serves as an independent risk factor for incident hypertension in middle-aged and elderly populations. Although CHG levels exhibited a population-wide decline during the follow-up period, baseline levels were more effective in identifying individuals at long-term high risk. This underscores the importance of initiating early, sustained, and intensified comprehensive risk management in this population.