Modelling of associations of systolic blood pressure (BP) and blood glucose (BG) with their explanatory factors in separate regressions treats them as having independent biological mechanisms. This can lead to statistical inferences that are unreliable because the substantial overlap in their etiologic and disease mechanisms is ignored.
This study aimed to examine the relationship of systolic blood pressure (BP) and blood glucose (BG) with measures of obesity and central fat distribution and other factors whilst taking account of the inter-dependence between them.
Participants (n = 14706, 53.5 % females) aged 25–64 years were selected by multi-stage stratified cluster sampling from eight provinces each representing one of the eight geographical regions of Vietnam. Measurements were made using the World Health Organization STEPS protocols.
Structural modelling identified direct effects for BG (men P = 0.000, women P = 0.029), age (men P = 0.000, women P = 0.000) and body mass index (BMI) (men P = 0.000, women P = 0.000) in the estimation of systolic BP, and for systolic BP (men P = 0.036, women P = 0.000) and waist circumference (WC) (men P = 0.032, women P = 0.009) in the estimation of BG. There were indirect effects of age, cholesterol, physical activity and tobacco smoking via their influence on WC and BMI. The errors in estimation of systolic BP and BG were correlated (men P = 0.000, women P = 0.004), the stability indices (men 0.466, women 0.495) showed the non-recursive models were stable, and the proportion of variance explained was mid-range (men 0.553, women 0.579).
This study provided statistical evidence of a feedback loop between systolic BP and BG. BMI and WC were confirmed to be their primary explanatory factors. Saturated fat intake and physical activity were identified as possible targets of intervention for overweight and obesity, and indirectly for reducing systolic BP and BG. Harmful/hazardous alcohol intake was identified as a target of intervention for systolic BP.
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We would like to thank The Atlantic Philanthropies Inc., USA for its financial support for data collection of the survey. We thank the Ministry of Health of the Socialist Republic of Vietnam and the provincial data collection teams for their contributions. We also thank Catrina Boon and Kate Butorac for their assistance with training and supervision of data collection teams.
This work was supported by The Atlantic Philanthropies Inc, United States (Grant number G0015338). NTTT is supported by a Tasmania Graduate Research Scholarship; LB was supported by a National Health and Medical Research Council Career Development Fellowship. SLG is supported by a National Heart Foundation of Australia Future Leader Fellowship (FLF100446). MC is supported by a National Health and Medical Research Council Boosting Dementia Leadership Research Fellowship (APP1135761).
Conflict of interest
We declare that we have no conflict of interest
NTT conducted analyses and interpreted the data, and drafted and revised the manuscript. CLB contributed to the conception and design of the study, supervised data collection, supervised data analyses and their interpretation, and revised the manuscript for important intellectual content. KNL contributed to the conception and design of the study, and revised the manuscript for important intellectual content. NLVT and BQT contributed to the conception and design of the study, supervised data collection, and revised the manuscript for important intellectual content. PO contributed to the conception and design of the study, supervised data collection, conducted analyses, and revised the manuscript for important intellectual content. MN, SG and CM supervised data analyses and their interpretation, and revised the manuscript for important intellectual content. TBA, STH, HNP, MHT, and MC contributed to the conception and design of the study, supervised data collection, and revised the manuscript for important intellectual content. TVB and VS supervised data analyses and their interpretation, and revised the manuscript for important intellectual content. All authors approved the final manuscript.
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Nga, T.T.T., Blizzard, C.L., Khue, L.N. et al. The Interdependence of Blood Pressure and Glucose in Vietnam. High Blood Press Cardiovasc Prev (2021). https://doi.org/10.1007/s40292-020-00431-9
- Blood pressure
- Blood glucose