OBJECTIVE: To evaluate the predictive value of the triglyceride-glucose waist circumference index (TyG-WC) for hyperuricemia (HUA) risk in the hypertensive population. METHODS: This prospective cohort study involved 831 hypertensive patients with normal uric acid levels, who underwent continuous health examinations for five years. Participants were categorized into four groups based on baseline TyG-WC quartiles, and the incidence of hyperuricemia was monitored in each group. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for HUA incidence were calculated using Cox proportional hazards regression analysis. The predictive ability of various TyG indices for HUA was evaluated using receiver operating characteristic curves. RESULTS: After five years of follow-up, 117 participants developed HUA. The cumulative incidence of HUA was significantly higher in the highest TyG-WC quartile (Q4) compared to the lowest quartile (Q1). The TyG-WC index demonstrated the highest predictive value, with an area under the curve of 0.685 (95% CI: 0.635-0.734) compared to other obesity-related TyG indices. After adjusting for confounding factors, per standard deviation increase in the TyG-WC index was associated with a 1.28-fold higher risk of developing HUA (95% CI: 1.04-1.56, P <
0.001). CONCLUSION: The TyG-WC index is a robust independent predictor of HUA risk in the hypertensive population. It provides a practical, reliable, and cost-effective tool for the early identification of high-risk individuals in this population.