Abstract
The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) reflects the balance between pro- and anti-atherogenic lipoproteins. This study aims to explore the relationship between NHHR and mortality among hypertension patients. Data from 17,075 hypertensive adults in the National Health and Nutrition Examination Survey (NHANES) were analyzed. Multivariate Cox regression and restricted cubic splines were used to assess the correlation between NHHR and mortality. A segmented Cox model evaluated threshold effects, and sensitivity analyses confirmed result robustness. Machine learning algorithms were used to establish a prediction model. Over a median follow-up of 84 months, 3625 deaths occurred. A U-shaped association was observed between NHHR and both all-cause and cardiovascular mortality, with threshold values at 2.32 and 2.65. Below these thresholds, NHHR was negatively associated with mortality, while values above the thresholds were positively associated. NHHR was classified as an important variable in the prediction model, with the random survival forest (rsf) algorithm showing superior performance. This study identified a U-shaped association between NHHR and mortality in hypertension patients, with threshold points at NHHR values of 2.32 and 2.65, indicating that NHHR is a potential predictor of mortality in patients with hypertension.