The relationship between cholesterol, high-density lipoprotein, and glucose index and hypertension: A study based on two national cohorts

Background Hypertension remains a major global public health concern and is strongly linked to metabolic dysregulation. The cholesterol–high-density lipoprotein–glucose index, a recently proposed composite marker that integrates lipid and glycemic parameters, has not been comprehensively investigated in relation to hypertension. Methods Data from two nationally representative cohorts were analyzed: the China Health and Retirement Longitudinal Study (CHARLS) for longitudinal evaluation and the US National Health and Nutrition Examination Survey (NHANES) for cross-sectional assessment. Logistic regression analyses were used to examine the association between the cholesterol–high-density lipoprotein–glucose index and hypertension. Restricted cubic spline models were applied to assess potential non-linear relationships, while receiver operating characteristic curves were employed to evaluate the discriminative capacity of the cholesterol–high-density lipoprotein–glucose index. Sensitivity analyses were conducted to confirm the robustness of the findings. Results A total of 4031 participants from CHARLS and 10,355 participants from NHANES were included. Higher cholesterol–high-density lipoprotein–glucose index values were significantly and independently associated with an increased risk of hypertension in both cohorts. In the CHARLS cohort, each one-unit increase in cholesterol–high-density lipoprotein–glucose corresponded to a 1.60-fold higher risk of hypertension after full adjustment, while in the NHANES cohort, the risk was 1.73-fold higher. Restricted cubic spline analysis indicated a linear association between cholesterol–high-density lipoprotein–glucose and hypertension. Receiver operating characteristic curve analyses demonstrated modest discriminative ability (AUC: 0.566 in CHARLS; 0.612 in NHANES). Sensitivity analyses supported the consistency and stability of these results. Conclusion The cholesterol–high-density lipoprotein–glucose index shows an independent and positive association with hypertension across diverse populations. However, its discriminative power as a standalone marker remains modest and should be interpreted with caution. Further prospective and mechanistic studies are needed to validate its clinical applicability and to explore the potential value of integrating cholesterol–high-density lipoprotein–glucose with other cardiometabolic risk indicators.