Abstract
BACKGROUND AND AIMS: Methylmalonic acid (MMA) is considered a potential risk factor for cardiovascular disease. Elevated plasma MMA has also been linked to mitochondrial dysfunction and oxidative stress, key features in the pathophysiology of hypertension. However, the association between plasma MMA and hypertension has not been addressed. This study aims to investigate the association between MMA and the prevalence of hypertension in the elderly. METHODS: A total of 2153 elderly participants (aged ≥ 65 years) from the US National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014 were included in this cross-sectional analysis. Weighted multivariable logistic regression and restricted cubic spline models were used to examine the association between MMA and hypertension in the elderly. RESULTS: Overall, the prevalence of hypertension among the study population was 71.3%. There was a linear and positive correlation between MMA levels and the prevalence of hypertension in the elderly. Compared to participants with MMA ≤ 133 nmol/L, those with MMA ≥ 244 nmol/L had an increased prevalence of hypertension in the multivariable adjusted model [OR (95% CI): 1. 60 (1.16, 2.20), P = 0.007]. CONCLUSION: Our study suggested that there was a potential independent association between increased MMA level and the presence of hypertension in the elderly. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-026-05542-0.