# Health‐Related Physical Fitness Associated With Hypertension Risk in Adults Living in Sub‐Plateau Environments

## TL;DR

This study finds that physical fitness indicators like BMI and waist-to-height ratio are linked to hypertension risk in adults living in sub-plateau regions, with differences between genders.

## Contribution

The study identifies gender-specific physical fitness indicators that predict hypertension risk in sub-plateau populations, offering insights for targeted prevention.

## Key findings

- Hypertension prevalence was 26.75% in males and 18.36% in females, both lower than national averages.
- BMI and waist-to-height ratio (WHtR) were positively linked to hypertension in males, while sit-and-reach (SAR) was negatively linked.
- Combined fitness indicators improved hypertension prediction accuracy in both genders.

## Abstract

This study aimed to investigate the associations between health‐related physical fitness (HPF) indicators and hypertension (HTN) risk among adults living in sub‐plateau regions and to explore gender‐specific differences, providing empirical evidence for cardiovascular health promotion and intervention. A cross‐sectional study was conducted from 2020 to 2022 in Ningxia, China, recruiting 3026 adults aged 20–59 years (1328 males and 1698 females). Ten HPF indicators across five dimensions, including body composition (body mass index, BMI; waist‐to‐hip ratio, WHR; waist‐to‐height ratio, WHtR), cardiorespiratory endurance (vital capacity, VC), muscular strength (grip strength, GS; back strength, BS; vertical jump, VJ), muscular endurance (push‐ups/knee push‐ups, PU/KPU; sit‐ups, SU), and flexibility fitness (sit‐and‐reach, SAR). Binary logistic regression was used to identify HTN‐related indicators, and receiver operating characteristic (ROC) analyses were performed to evaluate their predictive ability. The results showed that the prevalence of HTN was 26.75% in males, significantly higher than 18.36% in females (p < 0.05), both lower than the national average (males: 36.8%, females: 26.3%). Regarding the association, in males, BMI (odds ratio, OR = 1.120) and WHtR (OR = 1.673) were positively associated with HTN risk (p < 0.05), whereas SAR (OR = 0.975) showed a negative association (p < 0.05). In females, WHR (OR = 1.240) was positively associated with HTN (p < 0.05), while SU (OR = 0.960) showed a negative association (p < 0.05). ROC analysis indicated that WHtR and WHR were the best single predictors for males (area under the curve, AUC = 0.662) and females (AUC = 0.633), respectively, while combined indicators (BMI + WHtR + SAR in males; WHR + SU in females) further improved discrimination (AUC = 0.679 and 0.655). In conclusion, adults in the sub‐plateau region exhibited a lower prevalence of HTN with notable gender differences. WHtR and WHR are the most valuable gender‐specific screening indicators, and combined indices enhance predictive accuracy, offering practical guidance for early HTN prevention and management in sub‐plateau populations.