Background: The waist-height ratio (WHtR) is increasingly being studied as a simple and effective measure of central obesity. BMI does not reflect regional fat distribution. Reports have shown that WHtR is a better predictor of hypertension and cardiovascular diseases than traditional obesity indices body mass index (BMI) and waist circumference (WC). It remains controversial which anthropometric indicator could be the best predictor as a screening tool for hypertension.

Objectives: To examine the relative power of body mass index (BMI), waist circumference (WC), and waist- to-height ratio (WHtR) as a screening tool for hypertension among sampled population of Birbhum district, West Bengal.

Methods: Height, weight, waist, systolic and diastolic blood pressure, age, socio-economic and demographic data were recorded from 3640 adult population aged 40 years and above in rural and peri- urban areas (Suri-1 block) of Birbhum district, from June to December 2023. The study included 1822 men and 1818 women. Continuous variables are shown as mean, standard deviation and categorical variables as frequency and percentage. We used logistic regression analysis separately to find the effect of different obesity metrics. Odd Ratios (ORs) were reported within a 95% CI.

Results: The prevalence of obesity or overweight to body mass index (BMI) was 29.62%, by waist-to-height ratio (WHtR) was 62.17% and by waist circumference was 41.10%. The paper has shown among other things, the prevalence of hypertensive, pre-hypertensive was 22.17%, 46.98% among adults. Nearly 31.85% participants were normal.

Conclusion: This study showed that WHtR and WC are not inferior to BMI as a metric for obesity detection and hypertension prediction. Because of its low cost, simplicity of measurement and better ability to predict hypertension, it may become a more usable metric in health facilities of low and middle-income countries. The paper also suggests the urgent need to launch preventive programs to reduce prehypertension before it develops to be hypertension as a precautionary measure.