{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:18:43Z","timestamp":1787635123451,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prehypertension and hypertension are cardiovascular risk states. We examined whether biomarker-derived atherogenic, cardiometabolic, and adiposity indices were associated with blood pressure status in adults undergoing health examinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This hospital-based cross-sectional study included 2, 136 adults from the Health Examination Center of the Second Affiliated Hospital of Shandong First Medical University between 2024 and 2025. Blood pressure was classified as normal, prehypertension, or hypertension. Composite indices were reconstructed from anthropometric, biochemical, and questionnaire variables. Analyses included multivariable regression, quartiles, 3-knot restricted cubic splines, mixture analysis, incremental evaluation, explainable machine learning, subgroup analyses, and sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 983 participants with normal blood pressure (46.02%), 422 with prehypertension (19.76%), and 731 with hypertension (34.22%). In fully adjusted analyses, CVAI (OR, 2.17 (1.80-2.62); P&amp;lt;0.01), TyG-WC (OR, 1.94 (1.64-2.28); P&amp;lt;0.01), TyG-BMI (OR, 1.93 (1.66-2.26); P&amp;lt;0.01), and METS-IR (OR, 1.91 (1.63-2.24); P&amp;lt;0.01) showed the strongest standardized associations with abnormal blood pressure. The highest quartiles of CVAI, METS-IR, and TyG-WHtR had higher odds than the lowest quartiles (all P for trend &amp;lt;0.01). Cross-validated AUROC improved from 0.80 to 0.83 after adding clinical and index information. SHAP highlighted CVAI, age, fasting glucose, waist circumference, eGFR, and uric acid.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Composite indices integrating visceral adiposity, insulin resistance, and lipid burden were associated with prehypertension and hypertension. They may help characterize cardiometabolic risk clustering but are not substitutes for direct blood pressure measurement or diagnostic evaluation. These findings support association and screening-value inference, not causal or diagnostic claims.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1924726","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:23:24Z","timestamp":1787631804000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Atherogenic, cardiometabolic, and adiposity composite indices for identifying prehypertension and hypertension: conventional regression and explainable machine learning"],"prefix":"10.3389","volume":"17","author":[{"given":"Hao","family":"Sun","sequence":"first","affiliation":[{"name":"Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01330-1","article-title":"Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants","volume":"398","year":"2021","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.018912","article-title":"Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries","volume":"134","author":"Mills","year":"2016","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01225-8","article-title":"Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis","volume":"387","author":"Ettehad","year":"2016","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1511939","article-title":"A randomized trial of intensive versus standard blood-pressure control","volume":"373","author":"Wright","year":"2015","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600177","article-title":"Blood-pressure and cholesterol lowering in persons without cardiovascular disease","volume":"374","author":"Yusuf","year":"2016","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1161\/HYP.0000000000000065","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","article-title":"2023 ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension, endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)","volume":"41","author":"Mancia","year":"2023","journal-title":"J Hypertens"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 International Society of Hypertension global hypertension practice guidelines","volume":"75","author":"Unger","year":"2020","journal-title":"Hypertension"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2337\/diab.37.12.1595","article-title":"Banting lecture 1988. 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