Body roundness index (BRI) and waist-to-height ratio (WHtR) exhibited the highest discriminatory ability for hypertension among 10 obesity-related indicators in Chinese adults, with both showing nonlinear dose-response relationships and optimal cut-off values of 3.66 and 0.52, respectively.
The weighted prevalence of hypertension among Chinese adults in this national sample was 24.79%.
BRI and WHtR demonstrated the highest discriminatory ability for hypertension among the 10 obesity-related indicators evaluated.
The optimal cut-off values for identifying hypertension risk were BRI ≥ 3.66 and WHtR ≥ 0.52 in the overall population.
Each unit increase in BRI z-score was associated with a 51% increased odds of hypertension in the overall population.
Each unit increase in WHtR z-score was associated with a 53% increased odds of hypertension in the overall population.
BRI and WHtR both showed nonlinear dose-response relationships with hypertension.
BRI and WHtR, as abdominal obesity indices incorporating both waist circumference and height, showed highly consistent performance with each other across all analyses.
This research used data from over 117,000 Chinese adults to compare 10 different ways of measuring obesity and determine which best identifies people at risk for high blood pressure (hypertension). The study found that about 1 in 4 Chinese adults (24.79%) had hypertension. Among all the obesity measures tested, two body shape indices — the Body Roundness Index (BRI) and the waist-to-height ratio (WHtR) — were the best at distinguishing people with hypertension from those without, and they performed similarly to each other. Both measures use waist circumference and height together, capturing abdominal (belly) fat rather than just overall body weight. The study identified specific thresholds: a BRI of 3.66 or higher and a WHtR of 0.52 or higher were associated with roughly double the odds of having hypertension compared to people below those thresholds. Each standard deviation increase in either measure was linked to approximately 50% higher odds of hypertension. Importantly, the relationship between these measures and hypertension was not a simple straight line — it was nonlinear, meaning risk accelerated at certain levels rather than increasing at a constant rate. This research suggests that waist-based measures of body shape, particularly BRI and WHtR, may be more useful than traditional weight-based measures like BMI for identifying adults at elevated hypertension risk in large-scale health surveys. The identified cut-off values could potentially help in public health screening efforts, though the cross-sectional design of the study means it cannot confirm that higher abdominal obesity directly causes hypertension.
Wang C, Wu Y, Nie M, Duobujie, Xiao C, He W, et al.. (2026). Associations between various obesity-related indicators and hypertension: a national cross-sectional survey with 117,609 Chinese adults.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1925175