Presenting non-insulin-based indices of insulin resistance relevant to pre-hypertension: A systematic review and meta-analysis

Using reliable, simple, and cost-effective tools to identify pre-hypertension (pre-HTN) early is crucial for reducing the risk of cardiovascular disease (CVD). This systematic review and meta-analysis aimed to assess the association between the risk of pre-HTN and non-insulin-based indices. A comprehensive literature search was conducted across electronic databases, including PubMed, Web of Science, and Scopus, until January 2025. Cross-sectional studies investigating the relationship between pre-HTN and IR indices were included. Two investigators independently performed study screening, data extraction, and quality assessment. A random-effects model was used to pool effect sizes, with odds ratios (ORs) as the primary measure of effect. Overall, 15 studies met the inclusion criteria for this systematic review, and 14 were included in the meta-analysis. All were cross-sectional or employed a cross-sectional approach. The results of the random effects model showed that IR indices, including the fasting triglyceride and glucose index-to-body mass index (TyG-BMI), fasting triglyceride and glucose index-to-waist circumference (TyG-WC), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), metabolic score for insulin resistance (METS-IR), and fasting triglyceride and glucose index (TyG), increased the odds of pre-HTN significantly (P < 0.05). The diagnostic odds ratios (DORs) were 2.67 (95% CI: 2.39–2.97) for TyG and 3.45 (95% CI: 2.73–4.35) for TyG-BMI. This meta-analysis reveals that non-insulin-based IR indices are associated with a higher risk of pre-HTN. However, given the cross-sectional design of all included studies, a causal relationship cannot be inferred. As cost-effective and user-friendly tools, they could aid in the early detection and prevention of HTN, but further prospective and longitudinal research is needed to confirm these findings and establish causality.