Determinants of Hypertension in Bangladesh: A Case Study of Rajshahi District

Abstract

Hypertension is a silent killer of human life and the numbers of hypertensive patients are increasing globally and nationally. Therefore, the purpose of the study was to investigate age-specific hypertension patterns, alarming age for hypertension, and many determinants of hypertension in Bangladesh, e.g., feminine and nuptial determinants, socio-demographic determinants, health complication determinants, and body composition determinants. The data were collected from Rajshahi district using stratified multistage sampling with technique based on the scheduled questionnaire for this study. To identify the most important determinants, sophisticated statistical tools have been used such as percentage distribution, point bi-serial correlation, phi correlation, Pearson product-moment correlation, path analysis, boot strapping technique, binary backward logistic regression method including Likelihood ratio test, Hosmer-lemeshow test, Nagelkerke R2, Sensitivity and specificity, receiver operating characteristics (ROC) curve etc. It was found that the number of systolic hypertensive patients (60.40%) were greater than diastolic hypertensive patients (47.90%) in old age group (≥61 years) where diastolic hypertensive patients (7.40%) were greater than systolic hypertensive patients (3.80%) in young age group (≤39 years) and in middle age group (40-60 years) both are same. Hence, young age (≤39 years) was risk period for occurring diastolic hypertension than systolic and old age (≥61years) was risk period for occurring systolic hypertension than diastolic when middle age (40-60 years) was also risk period for occurring both type of hypertension. The differences between two same percentiles of systolic and diastolic blood pressure were varying from 51 mmHg to 93 mmHg for hypertensive respondents where it is same for normotensive. Hence, the abnormality (>40 mmHg) of the differences is an indicator of hypertension or prehypertension. From the view of proper critical analysis of impact of some key factors on hypertension, the study was divided into four aspects such as socio-demographic, feminine and nuptial, health complication and body composition aspects. About 28.10% hypertensive patients were due to socio-demographic aspect. Applying binary logistic regression model in the study of causal relationship, age was found as the most significant variable. i. e. age had positive significant impact on hypertension. Secondly, education had second most significant negative impact on hypertension and its odds ratio focus that for every increase of one year in education, the risk of hypertension increased 0.958 time. It was also found that sedentary life style, working hour (>8 hrs) per day, social stress, occupational stress and mental stress, hereditary hypertension, smoking, taking alcohol and taking excess salt had positive significant impact on raising hypertension where taking regular exercise had negative significant impact on hypertension. Hence, sedentary life style, working hour (>8) per day, social stress, occupational stress, mental stress, hereditary hypertension, smoking, taking alcohol, taking excess salt may be considered as risk factors for raising high blood pressure or hypertension. Though the age was found to be as the highest risk factor, but age increasing is out of human control. In the health complication aspect, the adult hypertensive patients were 30.60%. In the analysis of causal relationship (applying binary backward logistic regression method) between hypertension and other health complication, kidney disease was found as a significant variable. i. e. kidney disease had positive significant impact on hypertension and its odds ratio 5.428 indicates that the respondents with kidney disease had 5.428 times risk to occur hypertension than the respondent without kidney disease. Also, tumor, diabetes, sleep apnea, hypothyroidism, hyperthyroidism, tachycardia and overweight had the positive significant impact for occurring hypertension. After discussing the binary logistic regression it was further found that kidney disease, tumor, diabetes, sleep apnea, hypothyroidism, hyperthyroidism, tachycardia and overweight might be considered as risk factors for raising high blood pressure or hypertension. In selected feminine and nuptial aspect, the active married female hypertensive patients were 28.90%. In the study of causal relationship (applying backward binary logistic regression model) between hypertension and other feminine and nuptial characteristics, first menstruation age was found to be as significant variable. i. e. first menstruation age had negative significant impact on hypertension. Duration of couple life had significant positive significant impact on hypertension. Use of contraceptive method, menopause, pregnancy and miscarriage had positive significant impact for occurring hypertension compared with those who do not possesses the characteristics. Hence, first menstruation age, duration of couple life, use of contraceptive method, menopause, pregnancy and miscarriage might be considered as risk factors or determinants for raising high blood pressure or hypertension. Using path analysis, the total effect of body mass index, abdominal circumference and ratio of waist to hip on systolic blood pressure were 0.207, 0.185 and 0.118 respectively in which their direct effect were respectively 0.146, 0.082 and 0.047. The total effect of body mass index, abdominal circumference and ratio of waist to hip on diastolic blood pressure were 0.289, 0.231 and 0.138 respectively in which their direct effect were respectively 0.231, 0.079 and 0.043.