Study sample

The characteristics of the study sample according to sex are displayed in Table 1. In total, 9424 people aged between 18–92 years participated in this study (males, n = 4046, mean age = 42.5 ± 13.3 years, age range = 18–92 years; and females, n = 5378, mean age = 46.5 ± 13.1, age range = 18–87 years).

Table 1 Participant characteristics according to sex.

The overall prevalence of elevated BP was 11.8% (Table 2). Elevated BP was significantly more prevalent in males than females overall (14.8% vs 9.6%, p < 0.001), and within each adiposity category. Elevated BP was least prevalent in females within the first BF% tertile (5.3%) and most prevalent in males with a BMI ≥ 30 kg/m2 (29.4%) (Table 2).

Table 2 Prevalence of elevated blood pressure (BP) according to body mass index (BMI) and body fat (BF) %.Associations between grip strength, BMI/BF% and BP domains

Grip strength was positively associated with BMI (r = 0.214, p < 0.001) and negatively associated with BF% (r = −0.527, p < 0.001) (Fig. 1). Grip strength was positively associated with SBP (r = 0.227, p < 0.001), DBP (r = 0.034, p = 0.001), MAP (r = 0.132, p < 0.001) and PP (r = 0.255, p < 0.001) (Fig. 1).

Fig. 1: Associations between grip strength, measures of adiposity and blood pressure domains.

A grip strength and body mass index, B grip strength and body fat % and C–F grip strength and blood pressure domains.

Overall, SBP, PP, and MAP were positively associated with grip strength (all p < 0.001) after controlling for sex, age, BMI, disease prevalence, activity level, smoking status, education, and alcohol consumption (Table 3). No significant association was observed between DBP and grip strength (p = 0.786). Using the same regression model but substituting BF% for BMI, SBP, DBP, PP and MAP were all positively associated with grip strength (all p < 0.001) (Table 3).

Table 3 Association between blood pressure domains and grip strength.Differences in grip strength between those with normal BP and those with elevated BP according to BMI or BF%

Overall, those with elevated BP had significantly higher grip strength compared to those with normal BP (39.17 kg vs 38.38 kg, p < 0.001), while controlling for several confounders (Table 4). When stratified by BMI, those with elevated BP and a BMI of 25–29.9 kg/m2 or ≥30 kg/m2 had significantly higher grip strength than those with normal BP in the corresponding BMI category (42.08 kg vs 41.10 kg, p = 0.003 and 41.34 kg vs 40.03 kg, p = 0.033, respectively), whereas no significant differences were observed between individuals with elevated BP and normal BP with a BMI < 25 kg/m2. When stratified by BF%, those with elevated BP in the highest BF% tertile had significantly greater grip strength than those with normal BP in the same tertile (37.95 kg vs 36.52 kg, p < 0.001). No significant differences were observed between individuals with elevated BP and individuals with normal BP in BF% tertiles 1 and 2 (Table 4).

Table 4 Differences in grip strength between those with normal blood pressure (BP) and those with elevated BP according to body mass index (BMI) or body fat (BF) %.

Overall, females with elevated BP had significantly higher grip strength than those with normal BP (30.80 kg vs 30.28 kg, p = 0.026). Females with elevated BP had significantly higher grip strength than those with normal BP in the 25–29.9 kg/m2 and ≥30 kg/m2 BMI categories (30.65 kg vs 29.89 kg, p = 0.028 and 30.74 kg vs 29.55 kg, p = 0.040, respectively), but not in the <25 kg/m2 group. Similarly, females with elevated BP had significantly greater grip strength than those with normal BP in BF% tertile 3 (29.61 kg vs 28.76 kg, p = 0.009), while no significant differences were observed in BF% tertiles 1 and 2 (Table 4).

Overall, males with elevated BP had significantly higher grip strength than those with normal BP (50.21 kg vs 49.13 kg, p = 0.003). In the 25–29.9 kg/m2 BMI category and third BF% tertile, males with elevated BP had significantly higher grip strength compared to males with normal BP (51.07 kg vs 49.87 kg, p = 0.014 and 48.70 kg vs 46.71 kg, p < 0.001, respectively). No significant differences in grip strength were observed between males with elevated BP and normal BP in the <25 kg/m2 and ≥30 kg/m2 BMI groups, and in BF% tertiles 1 and 2 (Table 4).

Odds for elevated BP according to grip strength and low grip strength, stratified by BMI or BF%

Overall, higher grip strength was associated with an increased odds for elevated BP (OR = 1.014, 95% CI = 1.004–1.024, p = 0.004), after controlling for sex, age, BMI, disease prevalence, activity level, smoking status, education and alcohol consumption (Table 5). Following stratification by BMI/BF% and controlling for the same confounders (except BMI), positive associations between grip strength and elevated BP odds were observed in individuals within the 25–29.9 kg/m2 and ≥30 kg/m2 BMI groups (OR = 1.025, 95% CI = 1.010–1.039, p < 0.001 and OR = 1.018, 95% CI = 1.004–1.031, p = 0.010, respectively) and BF% tertile 3 (OR = 1.036, 95% CI = 1.022–1.051, p < 0.001). No significant differences were observed for those with a BMI < 25 kg/m2, or BF% within tertiles 1 or 2 (Table 5).

Table 5 Odds for elevated blood pressure according to grip strength, stratified by body mass index (BMI) or body fat (BF) %.

In females, higher grip strength was associated with increased odds for elevated BP across the full sample (OR = 1.027, 95% CI = 1.008–1.047, p = 0.005), and in those with a BMI of 25–29.9 kg/m2 or ≥30 kg/m2 (OR = 1.037, 95% CI = 1.005–1.070, p = 0.024 and OR = 1.050, 95% CI = 1.004–1.098, p = 0.034, respectively), or BF% within tertile 3 (OR = 1.038, 95% CI = 1.011–1.065, p = 0.006), but not in those with a BMI < 25 kg/m2 or BF% within tertiles 1 or 2. In males, higher grip strength was associated with an increased odds for elevated BP overall (OR = 1.012, 95% CI = 1.000–1.023, p = 0.042), and in those with a BMI of 25–29.9 kg/m2 (OR = 1.023, 95% CI = 1.007–1.039, p = 0.005), or BF% within tertile 3 (OR = 1.035, 95% CI = 1.018–1.053, p < 0.001), but not in those with a BMI < 25 kg/m2 or ≥30 kg/m2, or BF% within tertiles 1 or 2 (Table 5).

Those with low grip strength and a BF% within the highest tertile had significantly lower odds for elevated BP (OR = 0.514, 95% CI = 0.341–0.775, p = 0.002) (Table 6). The association remained significant when stratified by sex (males: OR = 0.387, 95% CI = 0.199–0.754, p = 0.005; females: OR = 0.573, 95% CI = 0.335–0.981, p = 0.043). In contrast, those with low grip strength and a BF% within the lowest tertile had significantly higher odds for elevated blood pressure (OR = 2.162, 95% CI = 1.026–4.555, p = 0.043), although the ORs were not significant when stratified by sex. No significant associations were found within BF% tertile 2.

Table 6 Odds for elevated blood pressure according to the presence of low grip strength, stratified by body fat (BF) %.Odds for elevated BP according to grip strength in young, middle-aged and older individuals, stratified by BF %

Within the highest BF% tertile, higher grip strength was associated with significantly greater odds for elevated BP in young and middle-aged individuals (OR = 1.065, 95% CI = 1.031–1.100, p < 0.001 and OR = 1.024, 95% CI = 1.005–1.043, p = 0.015, respectively), but not older individuals (Table 7). No significant associations were observed in BF% tertiles 1 or 2.

Table 7 Odds for elevated blood pressure according to grip strength in young, middle-aged and older individuals, stratified by body fat (BF) %.