Association Between Abdominal Obesity, Body Mass Index, and Hypertension in India: Evidence From a Large Nationally Representative Data

Abstract

Hypertension prevalence is rising among individuals with abdominal obesity in Southeast Asia, including India, but the relationship between abdominal obesity, body mass index (BMI), and hypertension remains underexplored. This study examines the association between these factors in a nationally representative Indian population aged 20–54 years (males: N = 78 832; females: N = 559 059). We analyzed data from the National Family Health Survey 2019–21 (NFHS-5). Hypertension was defined as a systolic blood pressure (SBP) ≥ 140 mm Hg, diastolic blood pressure (DBP) ≥ 90 mm Hg, or use of blood pressure-lowering medication. Abdominal obesity was defined by waist–hip ratio (>0.90 for men, >0.85 for women). BMI categories were underweight (<18.5 kg/m²), normal (18.5–<25.0 kg/m²), overweight (25.0–<30.0 kg/m²), and obese (≥30.0 kg/m²). Multivariable logistic regression adjusted for demographic and lifestyle factors was used to assess the link between BMI, abdominal obesity, and hypertension. Individuals with both obesity and abdominal obesity had significantly higher odds of hypertension, with males having 3.3 times (95% confidence interval [CI]: 2.9–3.7) and females 2.8 times (95% CI: 2.6–2.9) odds compared to those with normal BMI and no abdominal obesity. Both genders showed increased SBP and DBP by 3.0–5.0 mm Hg when abdominal obesity was present, regardless of BMI. Indian health programs should emphasize the risks of high BMI and abdominal obesity to reduce hypertension.