Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult population
Abstract Background As a major modifiable risk factor for cardiovascular diseases worldwide, hypertension novel biomarkers that integrate inflammatory and metabolic pathways may improve risk stratification. The association between the red cell distribution width-to-albumin ratio (RAR), a newly ident...
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2025-08-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-05072-1 |
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| author | Zihao Zhao Yuhong Ma Weizhong Huangfu |
| author_facet | Zihao Zhao Yuhong Ma Weizhong Huangfu |
| author_sort | Zihao Zhao |
| collection | DOAJ |
| description | Abstract Background As a major modifiable risk factor for cardiovascular diseases worldwide, hypertension novel biomarkers that integrate inflammatory and metabolic pathways may improve risk stratification. The association between the red cell distribution width-to-albumin ratio (RAR), a newly identified inflammatory biomarker, and hypertension has not been systematically evaluated in population-based studies. Methods A cross-sectional study included 7,878 adults. Weighted multivariable logistic regression and threshold effect models were employed to analyze nonlinear associations, with subgroup analyses exploring heterogeneity. Results RAR showed a linear positive association with hypertension (adjusted OR = 1.26 per unit, 95%CI:1.09–1.44, P < 0.05), a threshold effect was observed. Piecewise regression revealed a significant association when RAR ≥ 3.4, with a higher hypertension prevalence (adjusted OR = 1.34, 95%CI:1.17–1.54), while no association existed below 3.4 (P = 0.408). For those aged 40–60 years, the inflection point was RAR = 3.92 (95%CI:3.76–4.51), with stronger associations observed below this threshold (OR = 1.80, 95%CI:1.33–2.43). Subgroup analyses revealed significant heterogeneity: diabetics exhibited stronger associations than non-diabetics (interaction P = 0.02), and enhanced associations were also observed in females and individuals aged > 40 years. Conclusion This study confirmed a linear positive correlation between red blood cell distribution width and albumin ratio (RAR) and the prevalence of hypertension, RAR ≥ 3.4 was associated with higher hypertension prevalence and may help identify high-risk subgroups, particularly among diabetics, but its predictive value warrants validation through prospective cohort studies. |
| format | Article |
| id | doaj-art-8e78ff961edd42b9b74a44b66300b11d |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-8e78ff961edd42b9b74a44b66300b11d2025-08-20T03:42:23ZengBMCBMC Cardiovascular Disorders1471-22612025-08-0125111010.1186/s12872-025-05072-1Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult populationZihao Zhao0Yuhong Ma1Weizhong Huangfu2Department of General Practice, The Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of General Practice, The Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of General Practice, The Affiliated Hospital of Inner Mongolia Medical UniversityAbstract Background As a major modifiable risk factor for cardiovascular diseases worldwide, hypertension novel biomarkers that integrate inflammatory and metabolic pathways may improve risk stratification. The association between the red cell distribution width-to-albumin ratio (RAR), a newly identified inflammatory biomarker, and hypertension has not been systematically evaluated in population-based studies. Methods A cross-sectional study included 7,878 adults. Weighted multivariable logistic regression and threshold effect models were employed to analyze nonlinear associations, with subgroup analyses exploring heterogeneity. Results RAR showed a linear positive association with hypertension (adjusted OR = 1.26 per unit, 95%CI:1.09–1.44, P < 0.05), a threshold effect was observed. Piecewise regression revealed a significant association when RAR ≥ 3.4, with a higher hypertension prevalence (adjusted OR = 1.34, 95%CI:1.17–1.54), while no association existed below 3.4 (P = 0.408). For those aged 40–60 years, the inflection point was RAR = 3.92 (95%CI:3.76–4.51), with stronger associations observed below this threshold (OR = 1.80, 95%CI:1.33–2.43). Subgroup analyses revealed significant heterogeneity: diabetics exhibited stronger associations than non-diabetics (interaction P = 0.02), and enhanced associations were also observed in females and individuals aged > 40 years. Conclusion This study confirmed a linear positive correlation between red blood cell distribution width and albumin ratio (RAR) and the prevalence of hypertension, RAR ≥ 3.4 was associated with higher hypertension prevalence and may help identify high-risk subgroups, particularly among diabetics, but its predictive value warrants validation through prospective cohort studies.https://doi.org/10.1186/s12872-025-05072-1Red cell distribution width-to-albumin ratioHypertensionComplex sampling weightingNHANES |
| spellingShingle | Zihao Zhao Yuhong Ma Weizhong Huangfu Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult population BMC Cardiovascular Disorders Red cell distribution width-to-albumin ratio Hypertension Complex sampling weighting NHANES |
| title | Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult population |
| title_full | Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult population |
| title_fullStr | Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult population |
| title_full_unstemmed | Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult population |
| title_short | Red cell distribution width-to-albumin ratio and hypertension risk: age-specific threshold effects identified in the 2017–2020 NHANES U.S. Adult population |
| title_sort | red cell distribution width to albumin ratio and hypertension risk age specific threshold effects identified in the 2017 2020 nhanes u s adult population |
| topic | Red cell distribution width-to-albumin ratio Hypertension Complex sampling weighting NHANES |
| url | https://doi.org/10.1186/s12872-025-05072-1 |
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