To examine the association between anemia and hypertension among middle-aged and older Chinese women.

Baseline data of 5 575 women aged ≥45 years from the 2015 China Health and Retirement Longitudinal Study (CHARLS) were collected, with anemia in 2018 as the outcome. Multivariable logistic regression was used to assess cross-sectional and longitudinal relationships between anemia and hypertension. Restricted Cubic Splines (RCS) were used to analyze the dose-response relationship between hemoglobin and the risk of hypertension in middle-aged and elderly women.

Anemia was inversely associated with hypertension. In 2015, anemic women had a 25-35% lower prevalence of hypertension (Model 1: OR=0.65, 95% CI: 0.57-0.74; Model 4: OR=0.75, 95% CI: 0.63-0.88; both P<0.01). Over 2015—2018, baseline anemia reduced 3-year hypertension incidence by 42-50% (Model 1: OR=0.58, 95% CI: 0.43-0.79; Model 4: OR=0.50, 95% CI: 0.35-0.71; P<0.001). RCS showed a linear inverse relationship between hemoglobin level and hypertension risk. BMI influenced the strength of association, but no interaction was detected (all P > 0.05). Sensitivity analyses confirmed robustness.

Anemia is associated with lower prevalence and incidence of hypertension in middle-aged and older Chinese women.