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Adjustment for body mass index changes inverse associations of HDL-cholesterol with blood pressure and hypertension to positive associations

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Abstract

The associations between high-density lipoprotein cholesterol (HDL-C) and blood pressure (BP) or hypertension are inconsistent in previous studies. This study aimed to assess these associations in a large cohort of Chinese adults and across different age groups. This cross-sectional association study included 22,081 Chinese adults. Associations of HDL-C with BP and hypertension were analyzed using linear or logistic regression, with or without adjustment for confounding factors. HDL-C was inversely associated with BP and hypertension. These associations were still apparent after adjustment for age, sex, fasting plasma glucose, and low-density lipoprotein cholesterol. Sub-analyses revealed: (1) in the whole cohort and females alone, HDL-C was inversely associated with BP and hypertension in young and middle-aged but not older participants; (2) in males alone, HDL-C was not associated with systolic BP or hypertension. However, HDL-C was either inversely, or not, or positively associated with BP in young, middle-aged, and older males, respectively. After further adjustment for body mass index (BMI), the negative associations of HDL-C with BP and hypertension in the whole cohort became positive ones, and the positive associations only presented in males. These findings suggest that further adjustment for BMI changes inverse associations of HDL-cholesterol with BP and hypertension to positive associations in a cohort of Chinese adults.

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Fig. 1: BP over the concentration gradient of HDL-C.
Fig. 2: BP in people with low, normal, and high HDL-C concentrations.

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Data availability

Datasets are available from corresponding authors on reasonable request.

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Funding

This work was funded by the Shandong Natural Fund (ZR2015HL008), Shandong Province, China. YW is supported by a grant from the National Health and Medical Research Council of Australia (1062671). JG holds a Practitioner Fellowship from the National Health and Medical Research Council (1117061) and CGS holds a Senior Research Fellowship from the National Health and Medical Research Council of Australia. JG also holds a Senior Clinical Research Fellowship from the Queensland Government, Australia.

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Author notes

  1. These authors contributed equally: Guang Yang, Tingting Qian, Yutang Wang

Authors and Affiliations

  1. Department of Gerontology, the First Affiliated Hospital of Shandong First Medical University, **an, Shandong Province, China

    Guang Yang, Hui Sun & Qun Xu

  2. Department of Geriatric Medicine, School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, China

    Tingting Qian

  3. The Health Physical Examination Center, the First Affiliated Hospital of Shandong First Medical University, **an, Shandong Province, China

    Xujuan Hou, Wenqi Hu & Guang Zhang

  4. Centre for Cardiovascular Biology and Disease Research and Department of Physiology, Anatomy & Microbiology, School of Life Sciences, La Trobe University, Melbourne, VIC, Australia

    Grant R. Drummond & Christopher G. Sobey

  5. Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia

    Paul K. Witting

  6. Department of Physiology, Monash University, Melbourne, VIC, Australia

    Kate M. Denton

  7. Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia

    Kate M. Denton

  8. School of Science, Psychology and Sport, Federation University Australia, Ballarat, VIC, Australia

    Fadi J. Charchar & Yutang Wang

  9. Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

    Jonathan Golledge

  10. Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, QLD, Australia

    Jonathan Golledge

Authors
  1. Guang Yang
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  2. Tingting Qian
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  7. Guang Zhang
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Contributions

Conceptualization: GY, YW; Methodology: TQ, HS, QX; Formal analysis and investigation: YW; Writing—original draft preparation: YW, JG; Writing—review and editing: GRD, CGS, PKW, KMD, FJC; Funding acquisition: GY; Resources: XH; WH; GZ; Supervision: GY, YW.

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Correspondence to Guang Yang or Yutang Wang.

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Yang, G., Qian, T., Sun, H. et al. Adjustment for body mass index changes inverse associations of HDL-cholesterol with blood pressure and hypertension to positive associations. J Hum Hypertens 36, 570–579 (2022). https://doi.org/10.1038/s41371-021-00548-x

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