Abstract
Hypertension, a leading global health challenge, is intricately linked to obesity in its pathogenesis. Body mass index, a common indicator of obesity, cannot distinguish between fat mass and lean body mass, which exert contrasting cardiovascular effects. This study aimed to evaluate the lean body mass index (LBMI), derived from height, weight, and waist circumference, as a predictor of hypertension risk in men. This retrospective study utilized a large-scale real-world database to evaluate the association between LBMI and hypertension risk in men. Hypertension incidence was identified via ICD-10 codes (I10-I15) utilizing an administrative claims database. Cox regression and spline models assessed risk, adjusting for confounders. To confirm the robustness of findings, stratified and sensitivity analyses were also conducted. Among 384,551 men (median age 51 years), lower quartile in LBMI was associated with a higher risk of hypertension onset in multivariable Cox regression (hazard ratio [95% confidence interval]: Q1, 1.20 [1.15-1.26]; Q2, 1.06 [1.02-1.10]; Q3, 1.03 [0.99-1.06]; Q4, 1 [reference value]). In the restricted cubic spline regression model, the risk of hypertension increased as LBMI decreased. Consistent results were observed across stratified analyses, including older adults and non-obese individuals, and the reliability of the findings was confirmed through sensitivity analyses such as multiple imputation and competing risks analysis. In conclusion, lower LBMI was associated with a higher risk of hypertension in men, underscoring the importance of promoting lean body mass. Future research should explore whether increasing lean body mass could reduce hypertension incidence and its complications.