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The Interdependence of Blood Pressure and Glucose in Vietnam

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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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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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Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia

    Tran Thi Thu Nga, Christopher Leigh Blizzard, Petr Otahal, Mark R. Nelson, Costan G. Magnussen, Bui Van Tan, Au Bich Thuy, Phung Ngoc Hai, Tran Hoang Mai, Michele Callisaya & Seana Gall

  2. Medical Services Administration, Ministry of Health of the Socialist Republic of Vietnam, Hanoi, Vietnam

    Luong Ngoc Khue, Truong Le Van Ngoc, Tran Quoc Bao & Ha Thai Son

  3. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland

    Costan G. Magnussen

  4. Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia

    Velandai Srikanth & Michele Callisaya

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  1. Tran Thi Thu Nga
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Corresponding author

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 28, 141–150 (2021). https://doi.org/10.1007/s40292-020-00431-9

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