A total of 29,310 adults met the inclusion and exclusion criteria for this study (Table 1). The participants had an average age of 48.85 ± 17.47 years. Of the total, 11,489 (49.43%) were male, and 14,821 (50.57%) were female. In terms of ethnic distribution, 15.89% of participants were Mexican American, 9.95% were Other Hispanic, 42.6% were Non-Hispanic White, 20.34% were Non-Hispanic Black, and 11.23% belonged to other races. The average HDL-C level was 1.37 ± 0.42 mmol/L, and the mean PLT count was 246.27 ± 65.23 (1000 cells/µL). The prevalence of hypertension in the study population was 35.9%, with an average SBP of 122.55 ± 16.83 mmHg and an average DBP of 70.48 ± 11.39 mmHg.

The results of the study indicate a significant association between higher PHR and the incidence of hypertension (Table 2). In Model 1 (unadjusted for covariates), this association was significant (OR = 1.07; 95% CI, 1.04, 1.10, P < 0.001). Model 2, which adjusted for sex, age, race, educational level, and Family Poverty Income Ratio, also demonstrated a significant association (OR = 1.36; 95% CI, 1.32, 1.41, P < 0.001). Model 3, further adjusting for smoking, alcohol consumption, sleep disorders, waist circumference, diabetes, coronary heart disease, angina, myocardial infarction, and stroke, confirmed the association (OR = 1.13; 95% CI, 1.09, 1.17, P < 0.001). Additionally, the study examined the association between PHR and both SBP and DBP. A significant association was observed between PHR and SBP in Model 2 (OR = 1.00; 95% CI, 0.78, 1.21, P < 0.001) and Model 3 (OR = 0.32; 95% CI, 0.09, 0.54, P = 0.0056). Similarly, significant associations were found between PHR and DBP in Model 1 (OR = 0.90; 95% CI, 0.74, 1.06, P < 0.001), Model 2 (OR = 0.92; 95% CI, 0.76, 1.08, P < 0.001), and Model 3 (OR = 0.50; 95% CI, 0.33, 0.67, P < 0.001). The findings suggest that for every unit increase in PHR, the risk of developing hypertension increases by 13%, while SBP increases by 0.32 units and DBP by 0.50 units. To assess the robustness of the association between PHR and blood pressure, PHR was categorized into quartiles (Q1, Q2, Q3, Q4) for sensitivity analysis. The results showed that participants with the highest PHR levels had a 104% greater risk of hypertension compared to those with the lowest PHR levels (OR = 2.04; 95% CI, 1.89, 2.21, P < 0.001), accompanied by an increase of 2.22 units in SBP (OR = 2.22; 95% CI, 1.73, 2.72, P < 0.001) and an increase of 2.36 units in DBP (OR = 2.36; 95% CI, 1.99, 2.73, P < 0.001).

To further investigate the relationship between PHR and hypertension, Restricted Cubic Spline (RCS) curve plotting and threshold effect analysis were performed (Table 3; Fig. 2). The results indicated a non-linear association between PHR and hypertension, with a breakpoint identified at a PHR level of 280. Specifically, when PHR < 280, there was a significant positive correlation between PHR and hypertension (OR = 1.19; 95% CI, 1.13, 1.26, P < 0.001). However, when PHR > 280, no significant association was found between PHR and hypertension (OR = 1.03; 95% CI, 0.95, 1.12, P = 0.466). Similarly, a non-linear relationship was observed between PHR and SBP, with a breakpoint at PHR 129. When PHR > 129, SBP increased with higher PHR levels (OR = 0.54; 95% CI, 0.29, 0.79, P < 0.001). Additionally, a non-linear relationship was also found between PHR and DBP. When PHR < 341, DBP increased as PHR levels rose (OR = 0.81; 95% CI, 0.60, 1.02, P < 0.001). Detailed illustrations of these findings can be found in the supplementary materials.

The association between PHR and Hypertension

The nonlinear relationship between the PHR and Hypertension. Adjusted for sex, age, race, educational level, Family PIR, smoking, alcohol consumption, sleep disorders, waist circumference, diabetes, coronary heart disease, angina, myocardial infarction, and stroke.

To assess the stability of the association between PHR and hypertension across different subgroups, additional analyses were conducted based on previous research. Interaction tests revealed that the association between PHR and hypertension was not statistically significant in several subgroups, indicating that factors such as Family PIR, education level (Less Than 9th Grade, 9-11th Grade, High School Grad/GED or Equivalent, Some College or AA degree, College Graduate or above), waist circumference (cm), alcohol consumption (yes/no), sleep status (yes/no), diabetes (yes/no), coronary heart disease (yes/no), angina (yes/no), heart attack (yes/no), and stroke (yes/no) did not significantly influence this positive association (P > 0.05). However, significant interactions were found within subgroups based on gender (male/female), age, and race (Mexican American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black, Other race) (P < 0.05). Previous studies have shown that gender, age, and race are risk factors for hypertension, suggesting that the association between PHR and hypertension remains consistent across these subgroups (Fig. 3). Further analyses were conducted to explore the relationship between PHR and blood pressure levels (SBP and DBP) across subgroups. The results indicated that the interaction between PHR and blood pressure was not significant in subgroups based on race, Family PIR, education level, alcohol consumption, sleep status, coronary heart disease, and heart attack or stroke (P > 0.05). Detailed illustrations of these findings are available in the supplementary materials.

Subgroup analysis for the association between PHR and Hypertension