Prediction of hypertension by different anthropometric indices in adults: the change in estimate approach.

OBJECTIVE To examine the relative contribution for the prediction of hypertension by waist circumference (WC), waist:stature ratio (WSR) or waist:hip ratio (WHR) with that by BMI, to ascertain if WC, WSR or WHR enhances the prediction of hypertension by BMI. DESIGN Population-based, cross-sectional study. A change of >or=10 % in the prevalence ratio of BMI (PR) or the area under the receiver-operating characteristic curve (AUC) when WC, WSR or WHR was added to a model with BMI was used as the criterion for significant contribution to the prediction of hypertension by BMI. For greater contributions (>or=10 %) these waist measures were considered as better predictors. SETTING Nine provinces in China. SUBJECTS Chinese adults aged 18 to 65 years (n 7336) who participated in the 2004 China Health and Nutrition Survey. RESULTS The prevalence of hypertension (17 % and 23 % for women and men, respectively) was significantly related to increased BMI, WC, WSR and WHR (P for trend <0.001). Although there was a better model fit when WC, WSR or WHR was added to a model with BMI (P < 0.05; likelihood ratio test), the changes in PR and AUC were <10 % and <5 %, respectively. The sex-specific AUC for the prediction of hypertension by BMI (of 0.7-0.8) was similar to that by WC, WSR or WHR. CONCLUSIONS The waist indices do not perform better than BMI or markedly enhance the prediction of increased hypertension risk by BMI in Chinese adults.