To investigate the association between the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) and the incidence of hypertension in middle-aged and elderly Chinese adults, and to provide a reference for the development of hypertension intervention strategies.

This study included 6 231 participants from the baseline and 2015 follow-up data of the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression models were used to analyze the relationship between the TG/HDL-C ratio and the prevalence of hypertension in middle-aged and elderly populations. After excluding individuals diagnosed with hypertension before 2015, the cumulative TG/HDL-C ratio was calculated, and logistic regression models were employed to analyze the relationship between the cumulative TG/HDL-C ratio and the incidence of hypertension. Additionally, restricted cubic spline (RCS) models were used to fit the dose-response relationship between the cumulative TG/HDL-C ratio and the risk of hypertension in middle-aged and elderly populations.

From 2011 to 2015, 2 438 individuals (39.13%) were diagnosed with hypertension, and in 2015, 625 individuals (16.48%) developed hypertension. Logistic regression analysis revealed that an elevated TG/HDL-C ratio was significantly associated with an increased risk of hypertension (OR=1.02, 95% CI: 1.02-1.03). The highest quartile of the TG/HDL-C ratio was identified as a risk factor for hypertension (OR=1.34，95% CI：1.02-1.74). Furthermore, a linear association was observed between the cumulative TG/HDL-C ratio and the incidence of hypertension (P-nonlinear=0.232).

An elevated TG/HDL-C ratio is a risk factor for hypertension in middle-aged and elderly Chinese adults.