Waist-to-height ratio is a more accurate screening tool for hypertension than waist-to-hip circumference and BMI in type 2 diabetes: A prospective study

Background: To date, anthropometric measures (i.e. body mass index (BMI), waist to hip ratio (WHR) and waist to height ratio (WHtR) have shown to be associated with prediction of incident hypertension. However, the difference in accuracy of these measures has been of controversy. We aimed to determine whether WHtR is a more accurate tool for HTN than WHR and BMI in patients with type 2 diabetes. Material and Methods: The study population consisted of 1685 normotensive patients with T2DM. They were followed up for hypertension incidence for a mean of 4.8 years from April 2002 to January 2020. Cox regression was performed to assess the association between anthropometric measures (i.e., BMI, WHR, and WHtR) and incident hypertension during the follow-up period. Area under the ROC curve analysis was performed and optimal cutoff values were calculated using Youden index. Results: WHtR and BMI were significantly associated with an increased risk of hypertension (HR=3.296(0.936 to 12.857), P < 0.001 and HR:1.050 (1.030 to 1.070), P < 0.001, respectively). The discriminative powers of each anthropometric index for HTN were 0.571 (0.540 to 0.602) for BMI, 0.518 (0.486 to 0.550) for WHR, and 0.609 (0.578 to 0.639) for WHtR. The optimal cutoff points for predicting HTN in patients with T2DM were 26.94 (sensitivity=0.739, specificity=0.380) for BMI, 0.90 (sensitivity=0.718, specificity=0.279) for WHR and 0.59 (sensitivity=0.676, specificity=0.517) for WHtR. Conclusion: In the current study WHtR was a more accurate screening tool for HTN compared to WHR and BMI in patients with type 2 diabetes.