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. 2018 Jun 29;16(3):e59706.
doi: 10.5812/ijem.59706. eCollection 2018 Jul.

Factors Associated With Pre-Hypertension Among Tehranian Adults: A Novel Application of Structural Equation Models

Free PMC article

Factors Associated With Pre-Hypertension Among Tehranian Adults: A Novel Application of Structural Equation Models

Reza Taherian et al. Int J Endocrinol Metab. .
Free PMC article


Background: Pre-hypertension is proposed as an independent risk factor for the incidence of cardiovascular diseases.

Objectives: This study aimed to explore the main factors associated with pre-hypertension via testing a hypothesized model in Tehranian adults.

Methods: The study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) between 2009 - 2011 on 4640 adults without hypertension, aged ≥ 20 years.

Results: The mean age of participants was 38.61 ± 12.14 years and 56.6% of them were female. More than one third of the studied participants had pre-hypertension (35.4%) with significantly higher prevalence in males compared to females (46.5% vs. 26.9%; χ2 = 190.7, P < 0.001). Age, waist circumference (WC), and serum triglyceride concentrations (TG) were directly associated with pre-hypertension in both men (β = 0.16, β = 0.25, and β = 0.11, respectively) and women (β = 0.16, β = 0.21 and β = 0.09, respectively). Physical activity, only in men (β = 0.07), and marital status only, in women (β = -0.06), were also directly associated with pre-hypertension. Both healthy and poor dietary patterns showed indirect associations with pre-hypertension in both genders via WC and TG. Higher age and lower education in both genders, being married only in men, and unemployed status only in women, were positively associated with pre-hypertension via behavioral and cardio-metabolic factors.

Conclusions: Level of TG and WC in both genders are direct modifiable associated factors of pre-hypertension. These findings could be considered in designing future health promotion programs aimed at preventing high blood pressure and its consequences among Tehranian adults.

Keywords: Iran; Life Style; Prehypertension; Risk Factor.


Figure 1.
Figure 1.. The structural model: Testing the association of socio-behavioral and biochemical factors with pre-hypertension. Age, employment and marital status and education are exogenous independent variables. Behavioral factors including physical activity and dietary patterns are mediators and affect cardio-metabolic risk factors. Cardio-metabolic risk factors as another set of mediators affect on pre-hypertension. Pre-hypertension status considered as final dependent variable. Abbreviations: FBS, fasting blood sugar; HDL, high density lipoprotein; TG, triglycerides; WC, waist circumference.
Figure 2.
Figure 2.. Measurement model of healthy and poor dietary patterns: A CFA model based on 50% random sample data (n = 2320)
χ2 = 118.07, df = 33, χ2/df = 3.58, RMSEA = 0.033, RMR = 0.03, GFI = 0.99, CFI = 0.99, IFI = 0.97, NFI = 0.98, TLI = 0.97. Fit indices of the CFA model display appropriateness of measurement model of dietary patterns. The standardized factor loadings and related t statistics to evaluate the explained variances of food groups reported on path ways. All factor loadings are significant for healthy and poor dietary patterns (p < 0.001). According to factor loadings, healthy dietary pattern is defined as higher vegetable (yellow, red, green and other vegetables), higher fruits, lower refined grain and lower rice/pasta. Poor dietary pattern explained by high intake of fast foods, fruit juice, organ meats, drinks and, salty snacks. Abbreviations: CFA, confirmatory factor analysis; RMSEA, root mean square error of approximation; RMR, root mean square residual; GFI, goodness of fit index; CFI, comparative fit index; IFI, incremental fit index; NFI, normed fit index; TLI, Tucker-Lewis Index.
Figure 3.
Figure 3.. Final structural models in men (A) and women (B). The standardized effects of variables are presented on pathways for men and women. Abbreviations: HDL, high density lipoprotein; WC, waist circumference; TG, triglycerides; FBS, fasting blood sugar.

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