Objective To explore the mediating role of blood lipids in the relationship between obesity-related indicators and the risk of blood pressure control in hypertensive patients.

Methods Patients with essential hypertension who participated in the free community physical examination in a certain street of Zhongshan City from June to September 2023 were included as the research subjects. A total of 1 104 hypertensive patients with normal blood pressure were selected as the blood pressure controlled group, and 2 208 gender- and age-matched (1∶2) hypertensive patients with elevated blood pressure were selected as the blood pressure uncontrolled group. Data on obesity-related indicators, total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were collected. A regression model was employed to analyze the associations between obesity-related indicators or blood lipids and blood pressure. Furthermore, a mediating effect model was utilized to evaluate the role of blood lipids in the relationship between obesity-related indicators and blood pressure control in hypertensive patients.

Results There were significant differences in percentages of overweight/obesity, central obesity, dyslipidemia, high TC, high triglyceride and high LDL-C between the blood pressure controlled group and the blood pressure uncontrolled group (P＜0.05). Multivariate logistic regression analysis showed that overweight/obesity (OR=1.281, 95%CI 1.103–1.487), central obesity (OR=1.319, 95%CI 1.136–1.530), hip circumference >97 cm (OR=1.166, 95%CI 1.004–1.355), dyslipidemia (OR=1.266, 95%CI 1.090–1.471), hypercholesterolemia (OR=1.573, 95%CI 1.270–1.948), hypertriglyceridemia (OR=1.408, 95%CI 1.176–1.686), and elevated LDL-C (OR=1.690, 95%CI 1.257–2.273) were risk factors for blood pressure uncontrolled. Furthermore, overweight/obesity, central obesity, hip circumference >97 cm, and abnormal waist-to-hip ratio were risk factors of dyslipidemia, hypertriglyceridemia, and low HDL-C. Mediation analysis revealed that dyslipidemia partially mediated the effects of body mass index (BMI), waist circumference and hip circumference on blood pressure control, with triglycerides primarily mediating the relationship.

Conclusion Triglycerides play a mediating role in the association between BMI, waist circumference, hip circumference and blood pressure control among individuals with hypertension.