Handgrip Strength Predicts Cardiovascular Disease Prevalence and Mortality Among Hypertension Patients: Results from National Health and Nutrition Examination Survey (NHANES) 2011–2014

Abstract

Background: Handgrip strength (HGS) has emerged as a potential biomarker for cardiovascular risk, yet its predictive value in hypertensive populations remains unclear. This study aimed to investigate the association between HGS and cardiovascular disease (CVD) prevalence and mortality among hypertensive adults. Methodology: This cross-sectional study included 3,431 hypertensive participants from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 cycles, a nationally representative survey in the U.S., linked to mortality data through 2018. HGS was assessed using standardized grip strength protocols and categorized into quintiles. Logistic regression and Cox proportional hazards models were used to examine associations between HGS and CVD prevalence, all-cause mortality, and CVD-specific mortality, adjusting for demographic and clinical confounders. A two-sided p-value < 0.05 was considered statistically significant. Results: Individuals in the lowest HGS quintile (Q1: HGS <26.1 kg) had a 38% higher CVD prevalence (OR: 1.38, 95% CI: 1.28–1.52, p < 0.001), a 77% increased risk of all-cause mortality (HR: 1.77, 95% CI: 1.26–2.33, p < 0.001), and a 57% higher risk of CVD mortality (HR: 1.57, 95% CI: 1.10–2.21, p = 0.02) compared to those in the highest quintile (Q5: HGS >47.1 kg), even after adjusting for demographic and clinical factors. Conclusion: These findings suggest that HGS could be incorporated into cardiovascular risk stratification models to improve early detection strategies for hypertensive individuals. Unlike prior studies that focused on general or elderly populations, our study uniquely evaluates HGS as a predictor of CVD outcomes in hypertensive individuals, an understudied high-risk group.