Normalized creatinine-to-cystatin C ratio and risk of hypertension in middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study.

BACKGROUND AND AIM: The normalized creatinine-to-cystatin C ratio (NCCR) has recently emerged as a contributor to diabetes risk. However, its association with hypertension remains elusive. This study aimed to investigate this relationship in a large-scale prospective cohort.

METHODS AND

RESULTS

Based on the China Health and Retirement Longitudinal Study (CHARLS), a total of 4794 participants aged ≥45 years were enrolled from five CHARLS surveys in 2011, 2013, 2015, 2018 and 2020. Logistic regression models were used to investigate the association between NCCR and hypertension. The joint effects of body mass index and NCCR on the risk of hypertension were further analyzed. Additionally, the C-statistic was used to assess the predictive performance of NCCR for hypertension risk. During follow-up, 1318 (27.49 %) participants developed hypertension. After full adjustment for confounders, each per-SD increment in NCCR was associated with a significantly lower risk of hypertension (odds ratio [OR] = 0.81, 95% CI: 0.76 - 0.88, P < 0.001). Sex- and age-specific analyses revealed that the significant inverse associations between NCCR and hypertension were more pronounced in females and middle-aged individuals. Notably, non-obese participants with high NCCR experienced a more significant risk reduction than those who were obese with high NCCR. Moreover, incorporating NCCR into the basic model significantly improved the predictive ability for hypertension.

CONCLUSIONS

Higher levels of NCCR were independently associated with a decreased risk of hypertension in middle-aged and older adults, especially in females and middle-aged individuals.