Associations of sarcopenia and sarcopenic obesity with hypertension: a systematic review and meta-analysis
TL;DR
Sarcopenia and sarcopenic obesity were both significantly associated with hypertension, however, substantial heterogeneity and the observational nature of the evidence warrant cautious interpretation and preclude causal inference.
Abstract
Background Sarcopenia and sarcopenic obesity have been increasingly investigated in relation to hypertension, but observational findings remain inconsistent. This systematic review and meta-analysis aimed to quantitatively synthesize the associations of sarcopenia and sarcopenic obesity with hypertension in adults. Methods PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 20, 2026. Observational studies reporting associations of sarcopenia or sarcopenic obesity with hypertension were included. Effect estimates were pooled using random-effects restricted maximum likelihood models. Subgroup analyses were conducted according to study design, age, sarcopenia diagnostic criteria, and hypertension definition. Exploratory stratified analyses were additionally performed according to effect measure type [odds ratio (OR) versus hazard ratio (HR)]. The protocol was registered in PROSPERO (CRD420261393787). Results Nine studies involving 346,748 participants were included. Sarcopenia was significantly associated with hypertension (pooled relative effect estimate: 1.45, 95% CI: 1.08–1.94; p = 0.01; I2 = 95.51%). Sarcopenic obesity was also significantly associated with hypertension (pooled relative effect estimate: 2.49, 95% CI: 1.75–3.56; p < 0.001; I2 = 86.85%). Subgroup analyses generally showed associations in the same direction, although most tests for subgroup differences were not statistically significant. Exploratory analyses stratified by effect measure type did not identify statistically significant subgroup differences for sarcopenia (p = 0.10) or sarcopenic obesity (p = 0.26), although the HR strata were based on a limited number of studies. Leave-one-out sensitivity analyses retained the direction and statistical significance of the pooled associations. Because of the limited number of studies, publication bias assessments were considered exploratory. Conclusion Sarcopenia and sarcopenic obesity were both significantly associated with hypertension. However, substantial heterogeneity and the observational nature of the evidence warrant cautious interpretation and preclude causal inference. Further prospective studies using harmonized definitions and diverse populations are needed to clarify temporality, sources of heterogeneity, and potential clinical implications. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261393787, identifier CRD420261393787.