Age- and sex-specific predictive performance of obesity indices for hypertension in the Persian (Shahedieh) cohort study

Abstract

The rising global prevalence of obesity and its associated negative health outcomes impose a substantial burden on healthcare systems. This study aimed to investigate the predictive power of obesity-related indices for hypertension (HTN) in an Iranian population. This prospective study included 7793 individuals aged 35–70 years, without HTN, who were enrolled in the Shahedieh cohort study in 2016. During the 4-year follow-up period, HTN status was determined via annual telephone interviews. A conditional time-dependent receiver operating characteristic (ROC) curve was applied to estimate the predictive power of obesity-related indices, including Body mass index (BMI), waist circumference (WC), wrist circumference and Hip circumference, Waist- To- Height Ratio (WHtR), and Waist-to-hip Ratio (WHR) at different ages and separately for each sex. BMI predicted HTN well in middle-aged and older men, whereas it demonstrated acceptable predictive power in women aged under 60 years. Hip circumference showed acceptable predictive performance for men from middle age onwards, as well as for young and middle-aged women. Although WC could not predict HTN in young and older men, it showed approximately good predictive power for HTN in women across all age groups. WHR did not exhibit sufficient predictive power for HTN in men except at young ages, whereas it demonstrated good predictive power for women of all ages. WHtR and wrist circumference predicted HTN in men from middle age onwards. Similarly, HTN was well predicted in women of all ages except the elderly based on WHtR. The predictive power of wrist circumference fluctuated with age in women. BMI was the most reliable predictor for men, while for women, waist circumference and WHR performed best across most age groups, and these patterns seemed to hold up well despite the limited number of cases.