Shared Central Adiposity in Indian Couples Substantially Increases Hypertension Risk: AJPC Study, December 2025

A recent study highlighted the significant health implications of high waist-to-hip ratio (WHR) in Indian couples. The findings emphasized the importance of monitoring WHR as an anthropometric measure for assessing hypertension risk and managing related health conditions in both clinical and public health settings.

This comprehensive analysis is published in December 2025 in the American Journal of Preventive Cardiology.

Background - Central Adiposity and Spousal Risk

Central fat distribution plays a crucial role in cardiovascular health. Although body mass index (BMI) is commonly used, it poorly reflects true health risk because it cannot distinguish fat from muscle or capture fat distribution. Evidence shows that individuals with central (android) obesity, especially excess visceral fat, have markedly higher risks of metabolic disease than those with gynoid fat patterns. As a result, WHR is now considered a more reliable marker for cardiometabolic risk tied to abdominal fat. Earlier research has also shown that married couples often share similar weight patterns due to common lifestyle behaviors. However, the specific impact of high WHR on metabolic complications and hypertension among married Indian couples has remained poorly understood.

Study Overview

This cross-sectional study aimed to explore the prevalence of high WHR and its association with hypertension among Indian couples. Data were extracted from the fifth round of the National Family Health Survey (NFHS-5), a comprehensive population-based survey conducted in India from 2019 to 2021. A robust sample of 51,797 couples was included in the final analysis.

Hypertension was clinically defined if an individual's average systolic blood pressure was ≥140 mmHg, or their average diastolic blood pressure was ≥90 mmHg, or if they were currently taking prescribed medication to lower elevated blood pressure. Blood pressure was measured three times, and the last two readings were averaged. High WHR was defined according to World Health Organization (WHO) guidelines, specified as WHR >0.90 for men and WHR >0.85 for women. A Diet Diversity Index (DDI) was constructed using the frequency of consumption of healthy foods and unhealthy foods.

Key Findings from the Study

The results revealed a high prevalence of central adiposity and hypertension among the sample population. The overall prevalence of high WHR among the analyzed couples was 36.3%. The overall prevalence of hypertension was 43.7% among female spouses and 27.0% among male spouses.

The multivariable analysis confirmed the strong association between spousal WHR and hypertension, even after adjusting for background characteristics. Compared to couples with normal WHR:

• If only one spouse had a high WHR, both partners had higher odds of hypertension.

• When both spouses had high WHR, the risk of hypertension increased significantly: the odds of hypertension were 44% higher in female spouses and 56% higher in male spouses.

• Other significant risk factors associated with hypertension included older age and higher household wealth status for both male and female spouses.

This study provides unequivocal support that high WHR prevalence is a strong and independent risk factor for hypertension in Indian married couples. Considering that Asian Indians have a heightened propensity for accumulating central adiposity compared to other populations, routine monitoring of WHR is an imperative clinical measure.

Clinical Inference and Future Strategy

For practicing cardiologists and primary healthcare providers, these findings emphasize the critical need to routinely assess WHR alongside BMI and blood pressure, in line with consensus guidelines, for robust risk assessment of visceral obesity and hypertension in South Asian populations. Since the risk dramatically increases when both partners share a high WHR, interventions should move beyond the individual. The development of couple-focused lifestyle intervention programs—addressing dietary modification, physical activity, and behavioral counselling—is essential to reduce household-level hypertension risk and improve adherence to preventive measures.

Reference: Biradar RA, Prasad JB, Halli SS. Prevalence of high waist to hip ratio and its association with hypertension among married couples in India: A cross-sectional study. Am J Prev Cardiol. 2025 Sep 14;24:101302. doi: 10.1016/j.ajpc.2025.101302. PMID: 41078704; PMCID: PMC12510115.

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