Objective  To systematically investigate the association and dose-response relationship between the metabolic score for insulin resistance (METS-IR) and the risk of hypertension, using data from a prospective cohort study of Chinese adults.

Methods  A total of 4 866 adults without at baseline hypertension were enrolled from the 2009 China Health and Nutrition Survey (CHNS) and followed up for 6 years to observe new-onset hypertension. Multivariable logistic regression, restricted cubic spline analysis, and subgroup analyses were employed to comprehensively evaluate the relationship between METS-IR and hypertension risk.

Results During follow-up, 1 256 participants developed hypertension. Multivariable logistic regression analysis showed that METS-IR was an independent risk factor for hypertension. As a continuous variable, METS-IR showed a positive correlation with hypertension risk (OR=1.03, 95%CI: 1.02–1.05, P＜ 0.001). In quartile analyses, compared with the lowest quartile, the highest quartile of METS-IR was associated with increased hypertension risk (OR=1.73, 95%CI: 1.37–2.18, P＜0.001). Restricted cubic spline analysis confirmed a linear correlation between METS-IR and hypertension risk (P_nonlinear = 0.388). Subgroup analyses indicated no significant interaction effects of sex, smoking, alcohol consumption, region, body mass index, or age on this association (all P for interaction＞ 0.05).

Conclusion METS-IR serves as an independent risk factor for hypertension, with elevated levels demonstrating a robust positive correlation with hypertension risk.