AWR is independently and inversely associated with hypertension and blood pressure in U.S. individuals, exhibiting notable sex differences, highlighting the potential importance of peripheral-central body size distribution in hypertension development.
The prevalence of hypertension decreased progressively across increasing quartiles of arm-to-waist ratio (AWR).
Each 1% increment in AWR was associated with lower odds of hypertension after multivariable adjustment.
BMI, waist circumference (WC), waist-to-height ratio (WHtR), and arm circumference (AC) were all positively associated with hypertension, in contrast to AWR's inverse association.
Significant interaction effects were observed between AWR and both age and sex in their associations with hypertension.
Nonlinear associations were observed between AWR and hypertension, with differences by sex.
Among individuals without prior hypertension, increased AWR was independently associated with lower systolic blood pressure (SBP) and diastolic blood pressure (DBP).
This research suggests that how body size is distributed between the arms (peripheral) and the waist (central) matters for blood pressure and hypertension risk. Using data from over 50,000 U.S. adults collected between 1999 and 2018, researchers found that people with a higher arm-to-waist ratio (AWR) — meaning relatively larger arms compared to their waist — were significantly less likely to have hypertension. As AWR increased across four groups, the share of people with hypertension dropped from nearly half (47.5%) to less than one in five (16.9%). This pattern held even after accounting for other health and demographic factors. Interestingly, this finding runs counter to the pattern seen with other common body size measures like BMI, waist circumference, and waist-to-height ratio, all of which were associated with higher hypertension risk. The AWR's inverse relationship with blood pressure was also present among people who did not already have hypertension, where higher AWR was linked to lower systolic and diastolic blood pressure readings. The relationship between AWR and hypertension was not a simple straight line — it curved — and the pattern differed between men and women. This research suggests that where fat and muscle are distributed on the body — not just total body size — may be an important but underappreciated factor in understanding hypertension risk. Measuring the balance between arm size and waist size could potentially offer additional information beyond standard measurements like BMI when evaluating cardiovascular health risk. However, more research would be needed to understand the biological mechanisms involved and whether interventions that shift body size distribution could affect blood pressure outcomes.
Fang Z, Zhou Z, Zhang J, Zhang Y. (2026). Associations of Arm-to-Waist Ratio With Hypertension and Blood Pressure: The Role of Peripheral-Central Body Size Distribution in U.S. Individuals.. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70354