Abstract: Objective To investigate the dose-response relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the risk of hypertension among middle-aged and older adults in China, utilizing data from the China Health and Retirement Longitudinal Study (CHARLS). Methods A cross-sectional study design was employed. Participants meeting the predetermined inclusion and exclusion criteria were selected from the 2011 CHARLS database and stratified into hypertensive and non-hypertensive cohorts. The NHHR was calculated, and its association with the risk of hypertension was systematically analyzed. Results A total of 9 838 participants were included, of whom 4 350 (44.22%) had hypertension. Significant differences were observed between the two groups in age, smoking, alcohol consumption, physical activity, BMI, waist circumference, and NHHR (all P<0.05). Restricted cubic spline analysis revealed a non-linear curvilinear dose-response relationship between NHHR and hypertension risk. Multivariate logistic regression identified age ≥60 years (OR=1.320), smoking (former OR=1.138, current OR=1.111), alcohol consumption>15 g/day (OR=1.162), insufficient physical activity (OR=1.157), overweight (OR=1.169), obesity (OR=1.249), waist circumference (OR=1.024), and NHHR ≥2.64 (OR=1.733) as independent risk factors for hypertension (all P<0.05).Subgroup analyses showed that NHHR ≥2.64 consistently increased the risk of hypertension across all subgroups (all P<0.05). Significant interactions were found between age and NHHR (P<0.001), as well as between BMI and NHHR (P<0.001), whereas no significant interaction was observed between gender and NHHR. Sensitivity analyses confirmed consistency with the primary findings. Conclusion A non-linear dose-response relationship exists between NHHR and the risk of hypertension among the middle-aged and older Chinese population. This robust association persists across disparate age, sex, and BMI stratifications, indicating that age and BMI may synergistically modulate the pathogenesis and risk profile of hypertension.

Key words: Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio, Middle-aged and elderly, Hypertension, Dose-response, China Health and Retirement Longitudinal Study