The Interdependence of Blood Pressure and Glucose in Vietnam

Abstract

Introduction

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.

Aim

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.

Methods

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.

Results

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).

Conclusion

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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Fig. 1

References

  1. 1.

    Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet. 2012;380(9841):601–10.

    PubMed  Article  PubMed Central  Google Scholar 

  2. 2.

    Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  3. 3.

    Cheung BM, Li C. Diabetes and hypertension: is there a common metabolic pathway? Curr Atheroscler Rep. 2012;14(2):160–6.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Pandey AR, Karki KB, Mehata S, Aryal KK, Thapa P, Pandit A, et al. Prevalence and determinants of comorbid diabetes and hypertension in Nepal: evidence from non-communicable disease risk factors STEPS survey Nepal 2013. J Nepal Health Res Counc. 2015;13(29):20–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg. 2008;207(6):928–34.

    PubMed  Article  PubMed Central  Google Scholar 

  6. 6.

    Tiptaradol S, Aekplakorn W. Prevalence, awareness, treatment and control of coexistence of diabetes and hypertension in thai population. Int J Hypertens. 2012;2012:386453.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Cheung BM. The hypertension-diabetes continuum. J Cardiovasc Pharmacol. 2010;55(4):333–9.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  8. 8.

    Williams B. Blood pressure and diabetes: a fatal attraction. Eur Heart J. 2013;34(44):3395–7.

    PubMed  Article  PubMed Central  Google Scholar 

  9. 9.

    Fu SN, Luk W, Wong CK, Cheung KL. Progression from impaired fasting glucose to type 2 diabetes mellitus among Chinese subjects with and without hypertension in a primary care setting. J Diabetes. 2014;6(5):438–46.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  10. 10.

    Cho NH, Kim KM, Choi SH, Park KS, Jang HC, Kim SS, et al. High blood pressure and its association with incident diabetes over 10 years in the Korean Genome and Epidemiology Study (KoGES). Diabetes Care. 2015;38(7):1333–8.

    PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    Heianza Y, Arase Y, Kodama S, Hsieh SD, Tsuji H, Saito K, et al. Fasting glucose and HbA1c levels as risk factors for the development of hypertension in Japanese individuals: Toranomon hospital health management center study 16 (TOPICS 16). J Hum Hypertens. 2015;29(4):254–9.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  12. 12.

    Lee WY, Kwon CH, Rhee EJ, Park JB, Kim YK, Woo SY, et al. The effect of body mass index and fasting glucose on the relationship between blood pressure and incident diabetes mellitus: a 5-year follow-up study. Hypertens Res. 2011;34(10):1093–7.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Fukui M, Tanaka M, Toda H, Senmaru T, Sakabe K, Ushigome E, et al. Risk factors for development of diabetes mellitus, hypertension and dyslipidemia. Diabetes Res Clin Pract. 2011;94(1):e15–8.

    PubMed  Article  PubMed Central  Google Scholar 

  14. 14.

    World Health Organisation. WHO STEPS surveillance manual: The WHO STEPwise approach to chronic disease risk factor surveillance 2008. http://www.who.int/chp/steps/manual/en/. Accessed 5 July 2018.

  15. 15.

    Bui TV, Blizzard CL, Luong KN, Truong Nle V, Tran BQ, Ha ST, et al. Declining prevalence of tobacco smoking in Vietnam. Nicotine Tob Res. 2015;17(7):831–8.

    PubMed  Article  PubMed Central  Google Scholar 

  16. 16.

    Bui TV, Blizzard CL, Luong KN, Van Truong NL, Tran BQ, Otahal P, et al. Alcohol consumption in Vietnam, and the use of “Standard Drinks” to measure alcohol intake. Alcohol Alcohol. 2016;51(2):186–95.

    PubMed  Article  PubMed Central  Google Scholar 

  17. 17.

    Bui TV, Blizzard CL, Luong KN, Truong Nle V, Tran BQ, Otahal P, et al. Fruit and vegetable consumption in Vietnam, and the use of a “standard serving” size to measure intake. Br J Nutr. 2016;116(1):149–57.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  18. 18.

    Bui TV, Blizzard CL, Luong KN, Truong Nle V, Tran BQ, Otahal P, et al. Physical activity in Vietnam: estimates and measurement issues. PLoS One. 2015;10(10):e0140941.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  19. 19.

    Adcock AC. Discovering structural equation modelling using Stata. Revised. College Station: Stata Press; 2013.

    Google Scholar 

  20. 20.

    Conen D, Ridker PM, Mora S, Buring JE, Glynn RJ. Blood pressure and risk of developing type 2 diabetes mellitus: the Women’s Health Study. Eur Heart J. 2007;28(23):2937–43.

    PubMed  Article  PubMed Central  Google Scholar 

  21. 21.

    Emdin CA, Anderson SG, Woodward M, Rahimi K. Usual blood pressure and risk of new-onset diabetes: evidence from 4.1 million adults and a meta-analysis of prospective studies. J Am Coll Cardiol. 2015;66(14):1552–62.

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Mugo MNSC, Rao PG, et al. Hypertension and diabetes mellitus. In: Black HREW, editor., et al., Hypertension: a companion to Brawnwald’s Heart Disease. New York: Elesevier; 2007. p. 409.

    Google Scholar 

  23. 23.

    Patel SA, Ali MK, Alam D, Yan LL, Levitt NS, Bernabe-Ortiz A, et al. Obesity and its relation with diabetes and hypertension: a cross-sectional study across 4 geographical regions. Glob Heart. 2016;11(1):71-9.e4.

    PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Ramachandran A, Ma RCW, Snehalatha C. Diabetes in Asia. Lancet. 2010;375(9712):408–18.

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    Singh GM, Danaei G, Farzadfar F, Stevens GA, Woodward M, Wormser D, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One. 2013;8(7):e65174.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    Nishina M, Kikuchi T, Yamazaki H, Kameda K, Hiura M, Uchiyama M. Relationship among systolic blood pressure, serum insulin and leptin, and visceral fat accumulation in obese children. Hypertens Res. 2003;26(4):281–8.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  27. 27.

    Juutilainen A, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Type 2 diabetes as a “coronary heart disease equivalent”: an 18-year prospective population-based study in Finnish subjects. Diabetes Care. 2005;28(12):2901–7.

    PubMed  Article  PubMed Central  Google Scholar 

  28. 28.

    Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of the Obesity Society and the American Society of Hypertension. J Clin Hypertens (Greenwich). 2013;15(1):14–33.

    CAS  Article  Google Scholar 

  29. 29.

    Poirier P, Hernandez TL, Weil KM, Shepard TJ, Eckel RH. Impact of diet-induced weight loss on the cardiac autonomic nervous system in severe obesity. Obes Res. 2003;11(9):1040–7.

    PubMed  Article  PubMed Central  Google Scholar 

  30. 30.

    Stahl CH, Novak M, Lappas G, Wilhelmsen L, Bjorck L, Hansson PO, et al. High-normal blood pressure and long-term risk of type 2 diabetes: 35-year prospective population based cohort study of men. BMC Cardiovasc Disord. 2012;12:89.

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Kim MJ, Lim NK, Choi SJ, Park HY. Hypertension is an independent risk factor for type 2 diabetes: the Korean genome and epidemiology study. Hypertens Res. 2015;38(11):783–9.

    PubMed  PubMed Central  Article  Google Scholar 

  32. 32.

    Amoussou-Guenou D, Wanvoegbe A, Agbodandé A, Dansou A, Tchabi Y, Eyissè Y, et al. Prevalence and risk factors of hypertension in type 2 diabetics in Benin. Niger Postgrad Med J. 2015;5(04):227.

    Google Scholar 

  33. 33.

    Hayashi T, Tsumura K, Suematsu C, Endo G, Fujii S, Okada K. High normal blood pressure, hypertension, and the risk of type 2 diabetes in Japanese men. The Osaka Health Survey. Diabetes Care. 1999;22(10):1683–7.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Oguoma VM, Nwose EU, Ulasi II, Akintunde AA, Chukwukelu EE, Bwititi PT, et al. Cardiovascular disease risk factors in a Nigerian population with impaired fasting blood glucose level and diabetes mellitus. BMC Public Health. 2017;17(1):36.

    PubMed  PubMed Central  Article  Google Scholar 

  35. 35.

    Klop B, Elte JWF, Cabezas MC. Dyslipidemia in obesity: mechanisms and potential targets. Nutrients. 2013;5(4):1218–40.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  36. 36.

    Raatz SK, Conrad Z, Johnson LK, Picklo MJ, Jahns L. Relationship of the reported intakes of fat and fatty acids to body weight in US adults. Nutrients. 2017;9(5):438.

    PubMed Central  Article  CAS  Google Scholar 

  37. 37.

    Phillips CM, Kesse-Guyot E, McManus R, Hercberg S, Lairon D, Planells R, et al. High dietary saturated fat intake accentuates obesity risk associated with the fat mass and obesity-associated gene in adults. J Nutr. 2012;142(5):824–31.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Harris KK, Zopey M, Friedman TC. Metabolic effects of smoking cessation. Nat Rev Endocrinol. 2016;12(5):299–308.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  39. 39.

    Audrain-McGovern J, Benowitz NL. Cigarette smoking, nicotine, and body weight. Clin Pharmacol Ther. 2011;90(1):164–8.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  40. 40.

    Thuy AB, Blizzard L, Schmidt MD, Luc PH, Granger RH, Dwyer T. The association between smoking and hypertension in a population-based sample of Vietnamese men. J Hypertens. 2010;28(2):245–50.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    Green MS, Jucha E, Luz Y. Blood pressure in smokers and nonsmokers: epidemiologic findings. Am Heart J. 1986;111(5):932–40.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  42. 42.

    Primatesta P, Falaschetti E, Gupta S, Marmot MG, Poulter NR. Association between smoking and blood pressure: evidence from the health survey for England. Hypertension. 2001;37(2):187–93.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  43. 43.

    Liu X, Byrd JB. Cigarette smoking and subtypes of uncontrolled blood pressure among diagnosed hypertensive patients: paradoxical associations and implications. Am J Hypertens. 2017;30(6):602–9.

    PubMed  Article  PubMed Central  Google Scholar 

  44. 44.

    Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2018;71(19):2275–9.

    Article  Google Scholar 

  45. 45.

    Bui TV, Blizzard CL, Luong KN, Truong Nle V, Tran BQ, Otahal P, et al. National survey of risk factors for non-communicable disease in Vietnam: prevalence estimates and an assessment of their validity. BMC Public Health. 2016;16:498.

    PubMed  PubMed Central  Article  Google Scholar 

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Acknowledgements

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.

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Correspondence to Christopher Leigh Blizzard.

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Funding

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

Authors’ contributions

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

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Keywords

  • Blood pressure
  • Blood glucose
  • Inter-relationship