Haemoglobin Systolic Pressure Index Better Predicts CV Risk Than HbA1c or SBP Alone: Study

Hypertension and diabetes are major drivers of cardiovascular disease (CVD), and their coexistence confers excess risk. This study aimed to develop a hemoglobin A1c (HbA1c)-systolic blood pressure (SBP) index (HSI) to simultaneously capture glucose and blood pressure status and investigate the associations of baseline and cumulative HSI with incident cardiovascular disease. Data were drawn from three population-based cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the US Health and Retirement Study (HRS). Baseline Haemoglobin–Systolic Pressure Indexwas calculated as HbA1c (%) × SBP (mmHg)/100. Cumulative Haemoglobin–Systolic Pressure Index was derived from repeated measurements weighted by time intervals. Cause-specific Cox proportional hazards models were used to investigate linear associations of baseline and cumulative Haemoglobin–Systolic Pressure Index with incident cardiovascular disease. Additionally, restricted cubic splines were used to assess nonlinear relationships.

Results: A total of 6,822 participants from CHARLS, 3,640 from ELSA, and 5,709 from HRS were included, with median follow-up of 9.0, 10.0, and 12.3 years, respectively. Across all three cohorts, the combination of elevated HbA1c and SBP was associated with the highest cardiovascular disease risk. Higher baseline Haemoglobin–Systolic Pressure Index were significantly associated with increased risks of cardiovascular disease in the CHARLS (hazard ratio [HR] per 1 standard deviation [SD] increase =1.16, 95% confidence interval [CI] 1.11–1.22), ELSA (1.13, 95% CI 1.06–1.21), and HRS (1.14, 95% CI 1.10–1.19). Cumulative HSI levels were also significantly associated with elevated cardiovascular disease risk (CHARLS: HR per 1 SD increase = 1.19, 95% CI 1.12–1.26; ELSA: 1.14, 95% CI 1.04–1.26; HRS, 1.15, 95% CI 1.08–1.22). No evidence of nonlinearity between baseline Haemoglobin–Systolic Pressure Index and cardiovascular disease was detected. The associations were almost consistent across demographic and clinical subgroups. The predictive performance of Haemoglobin–Systolic Pressure Index was superior to HbA1c or SBP alone.

Haemoglobin–Systolic Pressure Index, a simple composite of HbA1c and SBP, was consistently associated with incident cardiovascular disease across three international cohorts. Its predictive ability exceeded that of HbA1c or SBP alone, highlighting it as a pragmatic tool for integrated cardiometabolic risk assessment. The findings warrant further clinical validation.

Reference:

Zhang R, Chen X, Zhou B, Xiang B, Zhu S. Hemoglobin A1c-systolic blood pressure index as a novel predictor of cardiovascular disease: evidence from three prospective cohorts. Front Endocrinol (Lausanne). 2026 Feb 18;17:1718936. doi: 10.3389/fendo.2026.1718936. PMID: 41788769; PMCID: PMC12956636.

Keywords:

HSI, Predicts, Cardiovascular Risk, HbA1c, SBP, Study, cardiovascular disease, diabetes mellitus, hemoglobin A1c, hypertension, prediction, systolic blood pressure, Zhang R, Chen X, Zhou B, Xiang B, Zhu S