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Introduction

Elevated blood pressure (BP) is one of the most prevalent causes of premature mortality and disability. According to World Health Organization (2011) estimates, globally around 9.4 million deaths occurring every year due to raised blood pressure and problem is growing. Raised blood pressure is a major risk factor for cardiovascular diseases (CVD) like myocardial infarction as well as hemorrhagic stroke and death if not managed early (WHO, 2011)

Smoking, alcohol consumption, obesity, high cholesterol and diabetes mellitus are the major risk factors for the development of higher BP (WHO, 2009). There are many number of cardiovascular tools were developed based on these risk factors to assess the future risk of developing CVD in both general and disease specific population (UK,2016; Wilson, 2016). A systematic review performed in 2014 reported that alcohol drinking, smoking, and diabetes mellitus important risk factors associated with raised BP (Naing et al. 2014, p. 100). Data from the Framingham studies showed that those who had normal BP compared to those with optimal BP had 1.6 and 2.5 times greater risk of development of CVD in men and women, respectively (Vasan et al. 2001, p. 1292). Early detection of subjects with higher risk factors, reducing modifiable risk factors and its treatment will be helpful in prevention and reduction of its burden. Hence, it is of prime importance to detect the individuals at risk of high blood pressure and the contributing factors. The aim of this study is to identify the risk factors in predicting raised blood pressure level among subjects aged greater than 18 years.

Methodology:

Study design and Study sample

Questionnaire based prospective observational cross sectional survey was conducted to assess the role of smoking and blood glucose levels on systolic blood pressure among subjects aged >18 years. During the study period the following variable were collected on predesigned data collection form; age, gender, highest educational level, history of blood pressure, history of diabetes, history of smoking, actual blood glucose level and actual blood pressure level. Subjects who were willing to participate and either of gender were included in the study. Subjects with incomplete information were excluded.

Statistical analysis

Multiple imputation technique was used to handle the missing values in data analysis. Categorical variables like gender, smoking status and past history of blood pressure were presented as number with percentages and continuous variables like age, blood glucose level, and blood pressure were presented as mean with standard deviation. Chi-square test was used for analysis of the categorical variables and independent t-test was used to compare the means among continues variablse. Multiple linear regression analysis was done to find out the predictor of raising blood pressure. All the descriptive and analytical statistics was done by using SPSS version 22.0 (SPSS Inc., Chicago, IL, USA).

Results

A total of 161 patients were included into the final analysis. Among included patients 57.1%were males (n=92).

Age

Most of the subjects (n=134) were distributed in the age range between 18-60 years and only 29 subjects were above the 60 years of age.

Mean blood pressure value was found in adults was found to be 124±16 whereas in elderly subjects (age >60 years) it was found to be 140±19. Statistically significant difference (p-0.000) was observed in blood pressure among the adults and elderly patients.

Mean blood sugar level in adults was found to be 6.05±1.4, whereas in elders it was found to be 6.9± 4.1. Statistically insignificant difference (p-0.56) was observed among adults and elderly population.

Mean wait circumference in adults was found to be 93.98±13, whereas in elders it was found to be 93.3±22. Statistically insignificant difference (p-0.85) was observed among adults and elderly population.

Gender

Among included subjects 57.1% (n=92) were males and 42.9% were females. Male subjects were found to be higher than females.

Average blood pressure in males was found to be 132.2±17, whereas in females it was found to be 121.42. Statistically significant difference was observed in blood pressure level (p=0.000).

Average blood sugar level in males was found to be 6.21±1.7, whereas in females it was found to be 6.1±2.6. There was statistically insignificant difference was observed in blood glucose level (0.927) between the male and females.

Mean wait circumference in males was found to be 96.9±15.6, whereas in females it was found to be 89.4±14.6.There was statistically insignificant difference was observed in Waist circumference (p=0.002) between the male and female.

Ranges

The range of Blood pressure was found to be 91-184  and the range of blood sugar level was found to be 3.3- 25 and the range of wait circumference was found to be 32-125.

After correlation analysis between the age and blood pressure level, the correlation coefficient was found to be 0.52 and it was found to be statistically significant (p-0.001) means increasing age associated with increase in blood pressure value. It indicates age is one of the risk factors to raise the blood pressure.

Correlation coefficient between the blood glucose level and blood pressure was found to be 0.228, and it was found to be statistically significant (p-0.004). It indicates that there was a good positive correlation existed between the blood glucose level and blood pressure.

The Correlation coefficient between the wait circumference and blood pressure was found to be 0.169 and it was found to be statistically significant (p-0.03). It indicates that there was a good positive correlation existed between the wait circumference and blood pressure.

Educational status

The blood pressure level in both HSC and bachelors it was found to be 128. There is statistically insignificant difference was observed among the educational status and blood pressure.

History of blood pressure, blood sugar, smoking were found to be statistically insignificant difference among gender.

Blood sugar level

The blood sugar level in the patients with past history of raised blood glucose level was found to be 7.10 whereas in other who don’t have the history of raised blood pressure it was 5.75±3.06. There was a statistically significant difference in blood glucose level was observed in patients with history of blood pressure.

Patient with past history of smoking had mean blood glucose level was 6.0±1.3, whereas in patients without past history of smoking had blood glucose level of 6.2±2.4. There was statistically insignificant (p-0.707) difference was observed in patient with history of smoking.

Patients who had already a history of raised blood glucose level were had blood glucose level 6.4±1.9, whereas other had 6.07±2.3. it was found there is statistically insignificant difference was observed in blood glucose level of patient with history of raised blood glucose level.

Blood pressure level

Patients who had history of raised blood pressure level had mean average systolic blood pressure of 132±18.5, it was higher than patient without history of raised blood pressure. There was a statistically significant association (p-0.011) was observed in patients with history of raised blood pressure. It indicates that patient who had history of raised BP had a more chance of getting higher blood pressure level.

Patients who had history of smoking had mean average systolic blood pressure of 130±16, it was higher than patient without history of smoking. But it has statically insignificant difference (p-0.199). Patient with history of raised blood glucose level had the blood pressure level of 131±5, it was higher (125±0.8) than patient without raised blood glucose level.

History of blood pressure, blood sugar, smoking were found to be statistically insignificant difference among gender.

Waist circumference

Patient who had history of smoking had waist circumference of 94.47 ± 19.6, whereas in other who don’t have past history of smoking had waist circumference of 93.5 ± 13.9. It shows that there was no statistically significant difference was observed in the wait circumference among patient with past history of smoking.

Patient who had history of raised blood glucose had wait circumference of 94.6 ± 17.5.6, whereas in other who don’t have past history blood glucose had wait circumference of 93.27±14.5.it show that there was no statistically significant difference (p-0.580) was observed in the wait circumference among patient with past history of smoking.

Patient who had history of raised blood pressure had wait circumference of 92.86 ± 18.9, whereas in other who don’t have past history of blood pressure had wait circumference of 94.68 ± 12.5. it show that there was no statistically significant difference (p-0.474) was observed in the wait circumference among patient with past history of smoking.

Predictors of raised blood pressure level

Multiple linear regression analysis was performed to explore the predictors of raised blood pressure. After multiple linear regression analysis it was found that blood sugar level, smoking and waist circumference were found to be statistically significant predictors of raised blood pressure level. This regression model explains less variance (7%) in raised blood pressure (Adjusted R2 =0.07). so it is indicating that even though predictors like smoking and blood sugar level showed good association with raised blood pressure they explaining less variance.

Table: 1 Differences in base line characters among adults and elderly population

Parameter	Adults (n = 132)		Elderly (n = 29)
	Mean BP	Standard deviation	Mean BP	Standard deviation	p-value
Blood pressure level	124.7	15.8	140.6	19.46	0.000*
Blood glucose level	6.05	1.42	6.93	4.11	0.056
Waist circumference	93.8	13.8	93.3	22.2	0.885

* p- Value < 005 is considered as statistically significant

 

Table: 2 Differences in base line characters of Blood pressure level

Parameter	Sample size	Blood pressure level (n=161)
		mean	Standard deviation	p-value
Patient with history of blood pressure	61	132.8	18.5	0.011*
Patient without history of blood pressure	100	125.1	16.3
Patient with history of smoking	47	130.6	16.2	0.199
Patient without history of smoking	104	126.9	17.9
Patient with history of blood glucose	57	131.5	18.1	0.026*
Patient with history of blood glucose	99	125.08	16.5

* p- Value< 005 is considered as statistically significant

 

Table3: Differences in base line characteristics of gender

Parameter	Male (n=92)	Female(n=69)	p-value
Blood Pressure level, mean(SD)	132.2 (16.2)	121.4 (16.7)	0.000*
Blood Sugar level, mean(SD)	6.2 (1.7)	6.1 (2.6)	0.927
Waist circumference, mean(SD)	96.9 (15.6)	89.4 (14.6)	0.002*
History of blood pressure, n (%)	40 (66.7)	20(33.3)	0.105
History of blood sugar, n (%)	36 (63.2)	21(36.8)	0.438
History of smoking, n (%)	30(63.8)	17(62.1)	0.45

 

Table 4: Predictors of raised blood pressure level

Parameter	R	R2	B	Std. Error	Β	p-value	95% confidence interval
							Lower Bound	Upper Bound
Constant	0.300	0.900	98.15	8.92		.000	80.520	115.785
Blood sugar level			1.834	.618	0.226	.003	.613	3.055
Waist circumference			.179	.086	0.159	.039	.009	.348
Smoking			4.228	2.980	0.108	.158	-1.658	10.113

R, R² change^, B= unadjusted coefficients, β = standard coefficients

 

Table: 5 Differences in basic characters of Waist circumference

Parameter	Sample size	Waist circumference  (n=161)
		Mean	Standard deviation	p-value
Patient with history of blood pressure	61	94.69	17.5	0.580
Patient without history of blood pressure	100	93.27	14.5
Patient with history of smoking	47	130.6	16.2	0.199
Patient without history of smoking	104	126.9	17.9
Patient with history of blood glucose	57	94.47	19.6	0.734
Patient with history of blood glucose	99	93.5	19.6

 

Table: 6 Differences in basic characters of Blood sugar level

Parameter	Sample size	Blood glucose level (n=161)
		mean	Standard deviation	p-value
Patient with history of blood pressure	60	6.4	1.9	0.334
Patient without history of blood pressure	100	6.07	2.3
Patient with history of smoking	47	6.07	1.3	0.707
Patient without history of smoking	104	6.22	2.4
Patient with history of blood glucose	57	7.01	3.06	0.001*
Patient with history of blood glucose	99	5.75	1.33

* p- Value < 005 is considered as statistically significant

 

A total of 161 patients were included into the final analysis. Among included patients 57.1%were males (n=92). Most of the subjects (n=134) were distributed in the age range between 18-60 years and only 29 subjects were above the 60years of age. Among total included subjects 54.1% of subjects had bachelor degree, 38% of subjects had history of BP, 37.6% subjects had past history of diabetes and only 30% of patients had smoking habit. Average age, systolic blood pressure and blood sugar level of the patients were found to be 45±14 years, 126±17.6, 6.2±2.17 respectively.

Statistically significant difference was observed in blood pressure level (p=0.000) and Waist circumference (p=0.002) between the male and female. There was statistically insignificant difference was observed in blood glucose level (0.927) between the male and females. History of blood pressure, blood sugar, smoking were found to be statistically insignificant difference among gender

Multiple linear regression analysis was performed to explore the predictors of raised blood pressure. After multiple linear regression analysis blood sugar level, smoking and waist circumference were found to be statistically significant predictors of raised blood pressure level. This regression model explains less variance (7%) in raised blood pressure (Adjusted R2 =0.07).

Discussion

The main findings of this study results showed that blood glucose level, and waist circumference were associated with raised blood pressure level. These results were in line with previous studies conducted by Zaw et al. (2010), in their study they reported that alcohol and blood glucose level, waist circumference and cholesterol level were major predictors of raised blood pressure. Blood pressure level and Waist circumference were found to be significantly different among males and females. These results were in concordance with study conducted by Shwe et al (2004). Several previously published studies have shown the relation of increased blood glucose levels and the waist circumference with elevated blood pressure, which was confirmed by this study, even though with a smaller sample. Further large scale and multi centric studies are required to be performed to confirm this association.

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