Abstract
<title>Abstract</title> <p>Background Hypertension is a highly prevalent cardiovascular disease associated with metabolic and vascular risks. This study was designed to investigate the association between the serum uric acid to high‑density lipoprotein cholesterol ratio (UHR) and hypertension risk, and to establish and validate a hypertension risk prediction nomogram. Methods Data were obtained from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). Subsequently, serum uric acid and high‑density lipoprotein cholesterol levels were extracted, and the UHR was calculated. Following this, baseline characteristics were summarized and compared. Furthermore, Extreme Gradient Boosting (XGBoost) was applied to evaluate feature importance. Then, logistic regression models were constructed with three progressive adjustment strategies to explore the independent association between UHR and hypertension risk. Additionally, stratified analyses were conducted to assess the stability of the UHR‑hypertension association across subgroups. Finally, a nomogram was established and evaluated. Results First, baseline analyses revealed that UHR was significantly associated with hypertension in both cohorts. Meanwhile, XGBoost feature importance analysis indicated that UHR contributed stably to hypertension prediction in both NHANES and CHARLS datasets. More importantly, multivariate logistic regression demonstrated that elevated UHR was independently and positively associated with increased hypertension risk in a graded manner, and the association remained robust after full covariate adjustment. Subsequently, stratified analyses confirmed that the positive association was consistent across most age, smoking, and comorbidity subgroups, with only minor effect modification detected in some subgroups. Ultimately, the constructed nomogram showed favorable calibration, clinical net benefit, and discriminative performance in both databases. Conclusion The UHR is an independent and stable predictive factor for hypertension. The UHR‑integrated nomogram shows reliable performance in hypertension risk stratification and may serve as a practical tool for early screening and individualized clinical assessment of hypertension.</p>