Sex, Age, and Blood Pressure Level and Their Predictive Correlation with Overweight/Obesity in Hypertension Patients Treated at Primary Care Facilities
Keywords:hypertension, overweight/obesity, cardiovascular risk factors
Objectives: To examine the predictive correlation that the factors of sex, age, and blood pressure level had with overweight/obesity in hypertension patients treated at primary care facilities.
Design: Descriptive correlational predictive study.
Methodology: This study was based on secondary data obtained from three cross-sectional study projects conducted on a total 782 hypertension patients. Based on the data, the patients were classifed: 1) into the obese (BMI ≥ 23.0 kg/m2) and non-obese (BMI < 23.0 kg/m2) groups, according to the Asian BMI criteria; 2) into six 10-year age groups (from under 45 as early adults to 85 or older as the oldest-old); and 3) into four JNC-7 blood pressure groups, according to their systolic and diastolic blood pressure readings. The correlations between the factors of sex, age, and blood pressure level were then analysed using the univariate logistic regression analysis, to identify their predictive power for overweight/obesity.
Results: Approximately two-thirds of the patients (66.2%) were overweight/obese, and no signifcant difference in obesity likelihood was observed between males and females (OR = 1.38, 0.93-2.06, p = 0.104). Overweight/obesity was found in a correlation with a young age and a high diastolic blood pressure, but not with a systolic blood pressure and the ability or inability to control the blood pressure according to the criteria.
Compared with the early adults, the middle-old and the oldest-old displayed a reduced overweight/obesity risk (OR 0.24, 95% CI 0.11-0.51, p = 0.000 and OR 0.14, 95% CI 0.05-0.37, p = 0.000, respectively). However, the risk increased three times amongst the middle adults (OR 2.79, 95% CI 1.10-7.03, p = 0.026). In addition, patients in pre-hypertension and hypertension stages were found to face two-time higher risk (OR
1.94, 95% CI 1.34-2.82, p = 0.000 and OR 2.14, 95% CI 1.09-4.16, p = 0.039, respectively).
Recommendations: A high prevalence of overweight/obesity is found in males and females with hypertension. The obesity risk increased amongst young people with high diastolic blood pressures. The risk was detected in patients in all systolic blood pressure categories, regardless of their blood pressure control ability or inability. For this reason, weight monitoring, weight control, and weight loss guidelines should be added to the routine care for all hypertension patients.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. Seventh Report of
the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure.
Ärnlöv J, Ingelsson E, Sundström J, Lind L. Impact of body mass index and the metabolic syndrome on
the risk of cardiovascular disease and death in middle-aged men. Circulation 2010;121(2):230-6.
Meigs JB, Wilson PWF, Fox CS, Vasan RS, Nathan DM, Sullivan LM, et al. Body mass index, metabolic
syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endo Metab 2006;91(8):2906-12.
Yoon K-H, Lee J-H, Kim J-W, Cho JH, Choi Y-H, Ko S-H, et al. Epidemic obesity and type 2 diabetes
in Asia. Lancet 2006;368(9548):1681-8.
Ndumele CE, Matsushita K, Lazo M, Bello N, Blumenthal RS, Gerstenblith G, et al. Obesity and
subtypes of incident cardiovascular disease. J Am Heart Assoc 2016;5(8):e003921. doi: 10.1161/
Zhou M, Offer A, Yang G, Smith M, Hui G, Whitlock G, et al. Body mass index, blood pressure, and
mortality from stroke: a nationally representative prospective study of 212,000 Chinese men. Stroke
D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular
risk profle for use in primary care: the Framingham heart study. Circulation 2008;117(6):743-53.
Kotchen TA. Obesity-related hypertension: pathophysiology, pathophysiology, and clinical management. Am J Hypertens 2010;23(11):1170-8.
Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factors, paradox, and
impact of weight loss. J Am Coll Cardiol 2009;53(21):1925-32.
Bundhamcharoen K, Odton P, Phulkerd S, Tangcharoensathien V. Burden of disease in Thailand: changes in health gap between 11999 and 2004. BMC Public Health 2011;11:53. doi: 10.1186/1471-2458-11-53.
Aekplakorn W, Inthawong R, Kessomboon P, Sangthong R, Chariyalertsak S, Putwatana P, et al. Prevalence
and trends of obesity and association with socioeconomic status in Thai adults: National Health Examination
Surveys, 1991-2009. J Obes 2014;2014:410259. doi:10.1155/2014/410259
Aekplakorn W. Prevalence, treatment, and control of metabolic risk factors by BMI status in Thai adults:
National Health Examination Survey III. Asia Pac J Public Health 2011;23(3):298-306.
Aekplakorn W, Kessomboon P, Sangthong R, Chariyalertsak S, Putwatana P, Inthawong R, et al.
for the NHES IV Study Group. Urban and rural variation in clustering of metabolic syndrome
components in the Thai population: results from the Fourth National Health Examination Survey 2009.
BMC Public Health 2011;11:854. doi: 10.1186/1471-2458-11-854.
Seubsman S, Lim LL-Y., Banwell C, Sripaiboonkit N, Kelly M, Bain C, et al. Socioeconomic status, sex, and obesity in a large national cohort of 15-87-year-old open university students in Thailand. J Epidemiol 2010;20(1):13-20.
Thawornchaisit P, de Looze F, Reid CM, Seubsman S, Sleigh A, for Thai Cohort Study Team. Healthrisk factors and the prevalence of hypertension: cross-sectional fndings from a national cohort of 87143 Thai Open University students. Glob J Health Sci 2013;5(4):126-41.
Jitnarin N, Kosulwat V, Rojroongwasinkul N, Boonpraderm A, Haddock CK, Poston WSC. Risk factors for overweight and obesity among Thai adults: results of the National Thai Food Consumption Survey. Nutrients 2010;2(1):60-74.
Banks E, Lim L, Seubsman S, Bain C, Sleigh A. Relationship of obesity to physical activity, domestic
activities, and sedentary behaviours: cross-sectional fndings from a national cohort of over 70,000 Thai
adults. BMC Public Health 2011;11:762. doi:10.1186/1471-2458-11-762
Neuman B, Fawcett J. (Eds.). The Neuman systems model. 4th ed. Upper Saddle River, NJ: Prentice Hall;
Huang PL. A comprehensive defnition for metabolic syndrome. Dis Model Mech 2009;2(5-6):231-7.
Brandes RP. Endothelial dysfunction and hypertension. Hypertension 2014;64(5):924-8.
Chookheaw J, Suwanno J, Sameanphet T. Predictors of risk level of developing coronary heart disease in
women with hypertension attending a rural community hospital. Journal of Nursing Division 2013;40(1):39-56. (in Thai)
Panthong U, Suwanno J, Petsirasan R, Sameanphet T. Prevalence of microalbuminuria among hypertensive persons attending primary care service. Journal of Nursing and Health Care 2016:34(1):93-
Barba C, Cavalli-Sforza T, Cutter J, Darnton-Hill I, Deurenberg P, Deurenberg-Yap M, et al., for
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363 (9403):157-63.
Jitnarin N, Kosulwat V, Rojroongwasinkul N, Boonpraderm A, Haddock CK, Poston WSC. Prevalence of overweight and obesity in Thai population: results of the National Thai Food Consumption Survey. Eat
Weight Disord 2011;16(4):e242-9.
Field A. Discovering statistics using SPSS. 3rd ed. London: SAGE Publications Ltd; 2009.