Visceral Adiposity Is Independently Associated with Hypertension in Thai Adults: A Case–Control Study

Background: Hypertension is a major public health challenge and a leading contributor to cardiovascular morbidity and mortality worldwide. Although obesity is a well-established risk factor for hypertension, the body composition characteristics most strongly associated with hypertension remain unclear. This study aimed to investigate the associations between body composition parameters and hypertension among Thai adults. Methods: This case–control study included 208 Thai adults aged ≥18 years, comprising 103 normotensive individuals and 105 individuals with hypertension. Blood pressure indices included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP), and rate-pressure product (RPP). Body composition was assessed using bioelectrical impedance analysis (BIA) and included overall and regional body composition parameters, including visceral fat level, fat mass, body fat percentage, and skeletal muscle mass. Differences between groups were examined, and multivariable logistic regression analyses were performed to identify factors independently associated with hypertension. Results: Compared with normotensive participants, individuals with hypertension were significantly older (p < 0.001) and more likely to be male (p = 0.010). They also exhibited significantly greater adiposity-related characteristics, including higher body weight (p = 0.001), body mass index (p = 0.001), body fat percentage (p = 0.023), fat mass (p < 0.001), visceral fat level (p < 0.001), and waist-to-hip ratio (p = 0.037), together with higher SBP, DBP, PP, MAP, and RPP (all p < 0.001). In Model 3, older age (OR = 1.06, 95% CI: 1.04–1.09; p < 0.001), male sex (OR = 5.35, 95% CI: 1.69–16.95; p = 0.004), and higher visceral fat level (OR = 1.16, 95% CI: 1.06–1.26; p < 0.001) were associated with hypertension, whereas skeletal muscle mass was not (OR = 1.03, 95% CI: 0.95–1.12; p = 0.438). Each one-unit increase in visceral fat level was associated with a 16% increase in the odds of hypertension. The final model demonstrated acceptable discrimination (AUC = 0.79, 95% CI: 0.72–0.85). Conclusions: A higher BIA-derived visceral fat level was associated with hypertension among Thai adults after adjustment for age, sex, and skeletal muscle mass, whereas skeletal muscle mass showed no independent association in the same model. These findings suggest that visceral fat distribution may provide complementary information in cardiometabolic assessment. However, prospective studies using imaging-based assessments are required to confirm these findings.