Abstract
Hypertension (HTN) is a major global contributor to cardiovascular morbidity and mortality. Insulin resistance is a key mechanistic factor in HTN development, yet its direct measurement is impractical in large population studies. Triglyceride–glucose (TyG) index derivatives and the Atherogenic Index of Plasma (AIP) have emerged as simple surrogate markers of metabolic dysfunction. However, limited evidence compares their associations withHTN across different glycemic statuses. This study aimed to evaluate the associations of TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), TyG-waist-to-hip ratio (TyG-WHR), and AIP with HTN in a large Iranian population and to determine whether these associations differ among normoglycemic, prediabetic, and diabetic subgroups. This cross-sectional analysis included 10,520 adults aged 35–70 years from the PERSIAN Guilan Cohort Study. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between each index and HTN. Discriminative performance was assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis. After adjusting for confounding factors, all evaluated indices were significantly associated with HTN in the overall population. The strongest association was observed for AIP (OR = 1.66, 95% CI: 1.43–1.93; P < 0.01), followed by TyG-WHtR (OR = 1.42, 95% CI: 1.35–1.50; P < 0.01), TyG-WHR (OR = 1.36, 95% CI: 1.30–1.43; P < 0.01), TyG-BMI (OR = 1.004, 95% CI: 1.004–1.005; P < 0.01), and TyG-WC (OR = 1.002, 95% CI: 1.001–1.002; P < 0.01). In the subgroup analysis based on glycemic status, AIP showed the strongest association among normoglycemic individuals (OR = 1.35, 95% CI: 1.10–1.67; P < 0.01), whereas TyG-WHR demonstrated the strongest association in the prediabetic group (OR = 1.27, 95% CI: 1.12–1.46; P < 0.01). Among individuals with diabetes, AIP again exhibited the strongest association (OR = 1.46, 95% CI: 1.09–1.97; P = 0.01). AIP exhibited the strongest association with HTN overall and within the normoglycemic and diabetic groups, while TyG-WHR was most strongly associated with HTN among prediabetic individuals. Although all TyG-derived indices and AIP were significantly associated with HTN, their relative strengths varied by glycemic status. Using the most relevant index for each metabolic category may improve risk stratification and support more targeted prevention strategies.