Background and aims We aimed to evaluate the effects of serum testosterone, obesity and their interaction on blood pressure (BP) parameters and hypertension among Chinese rural adults. Methods A total of 6199 adults were recruited from the Henan Rural Cohort Study. Serum testosterone was measured by liquid chromatography-tandem mass spectrometry. Logistic regression and linear regression were used to evaluate the association between testosterone, hypertension and BP parameters (including systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP)). A generalized linear model was performed to identify the interactive effects of testosterone and obesity on hypertension. Results High levels of serum testosterone were associated with a lower prevalence of hypertension in males (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.53, 0.89). After stratification by obesity, observed associations were only found in non-obese males. Each one-unit increase in ln-testosterone was associated with a 1.23 mmHg decrease in SBP, 0.97 mmHg decrease in DBP, and 1.05 mmHg decrease in MAP among males. Moreover, interactive effects between testosterone and obesity on hypertension and BP parameters were found, indicating that protective effects of serum testosterone on hypertension and BP parameters were counteracted and accompanied by increased values of obesity-related indicators in males, and additional testosterone increased BP parameters and prevalence of hypertension at high levels of waist-to-hip ratio and waist-to-height ratio in females. Conclusions Elevated levels of serum testosterone were associated with decreased BP parameters and prevalent hypertension in males, and obesity modifying effects of serum testosterone on BP parameters and hypertension.
