Remnant cholesterol, not LDL cholesterol, is associated with the risk of hypertension in the middle-aged and elderly population: Bushehr Elderly Health (BEH) cohort

Behnaz Esmaeili¹Shahnaz Esmaeili^2,3Noushin Fahimfar⁴Mostafa Rezaei Tavirani⁵Farideh Razi⁶Iraj Nabipour⁷Patricia Khashayar⁸Fatemeh Bandarian^9*

• ¹Department of Basic Medical Sciences, Khoy University of Medical Sciences,, Khoy,, Iran
• ²Department of Basic Medical Sciences, Torbat Jam Faculty of Medical Sciences,, Torbat Jam,, Iran
• ³School of Nursing, Tehran University of Medical Sciences,, Tehran, Iran
• ⁴Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences,, Tehran, Iran
• ⁵Proteomics Research center, Shahid Beheshti University of Medical Sciences,, Tehran, Iran
• ⁶Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences,, Tehran, Iran
• ⁷The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences,, Bushehr, Iran
• ⁸Department of Chemistry, Ghent University,, Ghent, Belgium
• ⁹Metabolomics and Genomics Research Center, Institute of Endocrinology and Metabolism, Tehran University of Medical Sciences, Tehran, Alborz, Iran

Background: Despite available studies, the link between dyslipidemia and hypertension remains unclear, particularly among different ethnicities, age groups, and genders. This study aimed to assess this association in the Iranian elderly population.In a cross-sectional study, we used data from phase II of the Bushehr Elderly Health Program (BEHP). Participants were divided into hypertensive and non-hypertensive groups based on their blood pressure. The association between lipid parameters and hypertension (HTN) was evaluated using multiple logistic regression analysis. Additionally, we conducted a subgroup analysis by gender, age, and BMI (Body Mass Index).Results: In this study, 1918 people with a mean age of 62.10±8.05 were included. Of them, 1133 (59.1%) were hypertensive, and 57.2% were females (1097). Among the lipid profiles, individuals with HTN had higher levels of triglyceride (TG) and remnant cholesterol (RC). There was a negative association between high-density lipoprotein (HDL-c) levels and high blood pressure 0.987(0.978-0.995), p:0.003, and a positive association between TG and RC≥30 levels and HTN ((1.003(1.002-1.005), p<0.001); (1.36 (1.123-1.648), p:0.002), respectively). This positive association was observed after full adjustment for age, gender, and BMI. While HDL-C was lower and RC levels were significantly higher only in the hypertensive people aged ≤65 (p<0.01), higher RC levels were observed in the hypertensive groups independent of BMI levels (p=0.004). Moreover, the levels of RC≥30 mg/dL were associated with the risk of HTN only in males.In the middle-aged and elderly hypertension population, there is a positive and statistically significant association between RC and HTN. This suggests that this indicator is associated with HTN, particularly in those with normal or subnormal levels of traditional risk factors. Moreover, this association may be affected by age and anthropometric parameters as well as life style factors.