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Seng LL, Liu CT, Wang J, Li J. Instrumental variable model average with applications in Mendelian randomization. Stat Med 2023; 42:3547-3567. [PMID: 37476915 DOI: 10.1002/sim.9819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/20/2023] [Accepted: 05/29/2023] [Indexed: 07/22/2023]
Abstract
Mendelian randomization is a technique used to examine the causal effect of a modifiable exposure on a trait using an observational study by utilizing genetic variants. The use of many instruments can help to improve the estimation precision but may suffer bias when the instruments are weakly associated with the exposure. To overcome the difficulty of high-dimensionality, we propose a model average estimator which involves using different subsets of instruments (single nucleotide polymorphisms, SNPs) to predict the exposure in the first stage, followed by weighting the submodels' predictions using penalization by common penalty functions such as least absolute shrinkage and selection operator (LASSO), smoothly clipped absolute deviation (SCAD) and minimax concave penalty (MCP). The model averaged predictions are then used as a genetically predicted exposure to obtain the estimation of the causal effect on the response in the second stage. The novelty of our model average estimator also lies in that it allows the number of submodels and the submodels' sizes to grow with the sample size. The practical performance of the estimator is examined in a series of numerical studies. We apply the proposed method on a real genetic dataset investigating the relationship between stature and blood pressure.
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Affiliation(s)
- Loraine Liping Seng
- Department of Statistics and Data Science, National University of Singapore, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Jingli Wang
- School of Statistics and Data Science, Nankai University, China
| | - Jialiang Li
- Department of Statistics and Data Science, National University of Singapore, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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Iddrisu AK, Besing Karadaar I, Gurah Junior J, Ansu B, Ernest DA. Mixed effects logistic regression analysis of blood pressure among Ghanaians and associated risk factors. Sci Rep 2023; 13:7728. [PMID: 37173375 PMCID: PMC10182051 DOI: 10.1038/s41598-023-34478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Blood pressure (BP) control is a global health issue with an increase in BP beyond the normal BP leading to different stages of hypertension in humans and hence the need to identify risk factors of BP for efficient and effective control. Multiple BP measurement have proven to provide BP readings close to the true BP status of the individual. In this study, we used multiple BP measurement data on 3809 Ghanaians to determine risk factors associated with BP. The data were obtained from World Health Organization study on Global AGEing and Adult Health. We defined high blood pressure (HBP) as [Formula: see text] 130/80 mmHg or normal as [Formula: see text] 130/80 mmHg. We provide summary statistics and also used the Chi-Square test to assess significance of association between HBP versus risk factors of HBP. The aim of this study is to identify risk factors of BP using the mixed effects logistic regression model. Data were analyzed using R version 4.2.2. The results showed that the risk of high blood pressure (HBP) decreases across the three measurement periods. There is reduced risk (OR = 0.274, 95% CI = 0.2008, 0.405) of HBP among male participants relative to female participants. The risk (OR = 2.771, 95% CI = 1.8658, 4.1145) of HBP increased by 2.771-folds among those who are 60 years and above relative to those below the age of 60 years. Those whose work involves/requires vigorous exercise has 1.631-fold increase in the risk (OR = 1.631, 95% CI = 1.1151, 2.3854) of HBP relative to those whose work does not involve vigorous exercise. There is approximately 5-folds increased in the risk (OR = 4.896, 95% CI = 1.9535, 12.2268) of among those who have ever been diagnosed with diabetes. The results also revealed high risk (OR = 1.649, 95%CI = 1.1108, 2.4486) of HBP among those who have formal education. The risk (OR = 1.009, 95% CI = 1.0044, 1.0137) of HBP increases with increasing weight and a reduced risk (OR = 0.996, 95% CI = 0.9921, 0.9993) of HBP with increasing height. We found that sad experience, either mild, moderate or severe, is associated with a reduced risk of HBP. Those who have vegetable servings at least 2 cups per day have increased risk of HBP and those who have fruits servings at least 2 cups per day is associated with a reduced risk of HBP, however this is not statistically significant. To achieve success in BP control, programs should be designed with the aim of reducing weight, educate those with formal eduction on issues relating to HBP. Those whose work requires vigorous exercise are recommended to have regular check-ups to ensure that pressure build-up in the lungs is cleared. SBP is lower for women at young age but continue to increase after menopause as their BP increase becomes salt-sensitive. Hence there is need to give more attention to menopausal women so as to improve BP. Both young and old individuals are recommended to practice regular exercise since this has shown to reduce risk of being overweight or becoming diabetic and reduces the risk of HBP at yong age and old age. Also, to improve blood pressure control, programs for management of blood pressure or hypertension should focus more short stature individuals since such people are more likely to experience HBP.
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Affiliation(s)
- Abdul-Karim Iddrisu
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana.
| | | | - Joseph Gurah Junior
- Department of Mathematics and ICT, St. Ambrose College of Education, Dormaa-Akwamu, Ghana
| | - Bismark Ansu
- Department of Mathematics and ICT, St. Ambrose College of Education, Dormaa-Akwamu, Ghana
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Cho HW, Jin HS, Eom YB. Genetic variants of FGFR family associated with height, hypertension, and osteoporosis. Ann Hum Biol 2023:1-26. [PMID: 36876654 DOI: 10.1080/03014460.2023.2187457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Hypertension and osteoporosis are the most common types of health problems. A recent study suggested that the fibroblast growth factor receptor-like protein 1 (FGFRL1) gene in giraffes is the most promising candidate gene that may have direct effects on both the skeleton and the cardiovascular system. AIM Our study purposed to replicate the finding that the FGFR5 gene is related to giraffe-related characteristics (height, hypertension, and osteoporosis), and to assess the associations between genetic variants of the FGFR family and three phenotypes. SUBJECTS AND METHODS An association study was performed to confirm the connections between hypertension, osteoporosis, and height and the FGFR family proteins (FGFR1 to FGFR5). RESULTS We identified a total of 192 genetic variants in the FGFR family and found six SNVs in the FGFR2, FGFR3, and FGFR4 genes that were associated with two phenotypes simultaneously. Also, the FGFR family was found to be involved in calcium signalling, and three genetic variants of the FGFR3 gene showed significant signals in the pituitary and hypothalamus. CONCLUSION Taken together, these findings suggest that FGFR genes are associated with hypertension, height, and osteoporosis. In particular, the present study highlights the FGFR3 gene, which influences two fundamental regulators of bone remodelling.
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Affiliation(s)
- Hye-Won Cho
- Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, Chungnam 31538, Republic of Korea
| | - Hyun-Seok Jin
- Department of Biomedical Laboratory Science, College of Life and Health Sciences, Hoseo University, Asan, Chungnam 31499, Republic of Korea
| | - Yong-Bin Eom
- Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, Chungnam 31538, Republic of Korea.,Department of Biomedical Laboratory Science, College of Medical Sciences, Soonchunhyang University, Asan, Chungnam 31538, Republic of Korea
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Perez-Sastre MA, Ortiz-Hernandez L. Changes in blood pressure according to stature in Mexican adults. Rev Saude Publica 2021; 55:87. [PMID: 34878088 PMCID: PMC8647983 DOI: 10.11606/s1518-8787.20210550032531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE: To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults. METHODS: We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old (n = 7,130). We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs. RESULTS: In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased. CONCLUSIONS: Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature.
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Affiliation(s)
- Miguel A Perez-Sastre
- Universidad Nacional Autónoma de México. Programa de Maestría y Doctorado en Ciencias Médicas y Odontológicas y de la Salud. Ciudad de México, México
| | - Luis Ortiz-Hernandez
- Universidad Autónoma Metropolitana unidad Xochimilco. Departamento de Atención a la Salud. Ciudad de México, México
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Appiah F, Ameyaw EK, Oduro JK, Baatiema L, Sambah F, Seidu AA, Ahinkorah BO, Budu E. Rural-urban variation in hypertension among women in Ghana: insights from a national survey. BMC Public Health 2021; 21:2150. [PMID: 34819048 PMCID: PMC8611890 DOI: 10.1186/s12889-021-12204-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Hypertension is one of the leading causes of cardiovascular morbidities in Ghana and represents a major public health concern. There is dearth of information on the rural-urban disparity in hypertension among women in Ghana. Therefore, this study aimed at examining the rural-urban variation in hypertension among women in Ghana. Methods We extracted data from the women’s file of the 2014 Ghana Demographic and Health Survey. The sample included 9333 women aged 15–49 with complete data on hypertension. The analysis was done using Pearson Chi-square and binary logistic regression at 95% confidence interval. The results of the binary logistic regression were presented as Odds Ratios (ORs) and Adjusted Odds Ratios (AORs). Statistical significance was set at p < 0.05. Results Hypertension prevalence among urban and rural residents were 9.5% and 5.1% respectively. Rural women had lower odds of hypertension [OR = 0.59; 95% CI = 0.52, 0.67] compared to urban women, however, this was insignificant in the adjusted model [aOR = 0.84; 95% CI = 0.70, 1.00]. The propensity to be hypertensive was lower for women aged 15–19 [aOR = 0.07; 95% CI = 0.05, 0.11]. The poorest were less likely to be hypertensive [aOR = 0.63; 95% CI = 0.45, 0.89]. Single women were also less probable to have hypertension [aOR = 0.66; 95% CI = 0.46, 0.97]. Conclusions Women from urban and rural areas shed similar chance to be hypertensive in Ghana. Therefore, the health sector needs to target women from both areas of residence (rural/urban) when designing their programmes that are intended to modify women’s lifestyle in order to reduce their risks of hypertension. Other categories of women that need to be prioritised to avert hypertension are those who are heading towards the end of their reproductive age, richest women and the divorced.
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Affiliation(s)
- Francis Appiah
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana. .,Department of Social Sciences, Berekum College of Education, Berekum, Bono Region, Ghana.
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Joseph Kojo Oduro
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Linus Baatiema
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana.,Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana
| | - Francis Sambah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Estate Management, Takoradi Technical University, Takoradi, Ghana.,Centre For Gender and Advocacy, Takoradi Technical University, P. O. Box 256, Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Eugene Budu
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
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Cochran JM, Siebert VR, Bates J, Butulija D, Kolpakchi A, Kadiyala H, Taylor A, Jneid H. The Relationship between Adult Height and Blood Pressure. Cardiology 2021; 146:345-350. [PMID: 33721862 DOI: 10.1159/000514205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification and modification of cardiovascular risk factors is paramount to reducing cardiovascular disease morbidity and mortality. Hypertension is a major risk factor for cardiovascular disease, but its association with height remains largely underrecognized. OBJECTIVES The objective of this manuscript is to review the evidence examining the association between blood pressure and human stature and to summarize the plausible pathophysiological mechanisms behind such an association. METHODS A systematic review of adult human height and its association with hypertension and coronary artery disease was undertaken. The literature evidence is summarized and tabulated, and an overview of the pathophysiological basis for this association is presented. RESULTS Shorter arterial lengths found in shorter individuals may predispose to hypertension in a complex hemodynamic interplay, which is explained predominantly by summated arterial wave reflections and an elevated augmentation index. Our systemic review suggests that an inverse relationship between adult height and blood pressure exists. However, differences in the studied populations and heterogeneity in the methods applied across the various studies limit the generalizability of these findings and their clinical application. CONCLUSION Physiological studies and epidemiological data suggest a potential inverse association between adult height and blood pressure. Further research is required to define the relationship more clearly between adult height and blood pressure and to assess whether antihypertensive therapeutic approaches and goals should be modified according to patients' heights.
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Affiliation(s)
- John Michael Cochran
- Department of Internal Medicine, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA.,Department of Cardiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Vincent R Siebert
- Department of Internal Medicine, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA.,Department of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Jeffrey Bates
- Department of Internal Medicine, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Djenita Butulija
- Department of Internal Medicine, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Anna Kolpakchi
- Department of Internal Medicine, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Himabindu Kadiyala
- Department of Internal Medicine, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Addison Taylor
- Department of Internal Medicine, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine and the Michael E DeBakey VA Medical Center, Houston, Texas, USA,
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Gupta RD, Akonde M, Sajal IH, Al Kibria GM. Association between height and hypertension among US adults: analyses of National Health and Nutrition Examination Survey 2007-18. Clin Hypertens 2021; 27:6. [PMID: 33637121 DOI: 10.1186/s40885-021-00164-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Previous studies that investigated association of height with prevalence and control of hypertension found mixed results. This cross-sectional study explored these associations among US adults (≥20 years). Methods The National Health and Nutrition Examination Survey (NHANES) 2007–18 data was analyzed. Height was measured in meters and was converted into centimeters (cm) and was further divided into quartiles: Q1 (135.3–159.2 cm), Q2 (159.3–166.2 cm), Q3 (166.3–173.6 cm), Q4 (173.7–204.5 cm). Hypertension definition of the ‘2017 American College of Cardiology/American Heart Association Guideline’ was used. Logistic regression analyses were conducted to find out the association between the dependent variable and the covariates. Linear regression analyses were conducted to find out the association of height with systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and the covariates among the individuals who were not taking any antihypertensive drugs. Crude odds ratio, adjusted odds ratio (AOR), and adjusted beta-coefficient (for linear regression) with 95% confidence interval (CI) were reported. The following covariates were included: age, gender, race/ethnicity, family income, education level, cholesterol level, high-density lipoprotein level, chronic kidney disease status, diabetes status, smoker, aerobic leisure-time physical activity, and survey period. Sample weight of NHANES was adjusted. Results Among the 21,935 participants (47.1% males), the prevalence of hypertension was 46.1%. Among 6154 participants taking medication (43.0% males), 57.2% had uncontrolled hypertension. In the final logistic regression analyses, participants in Q2 height quartile had 20% lower odds of being hypertensive compared to those in Q4 height quartile (AOR: 0.8; 95% CI: 0.7,1.0). Other height categories did not reveal any significant association. Compared to Q4 height category, Q1 (AOR: 1.7; 95% CI: 1.2,2.3), Q2 (AOR: 1.4; 95% CI: 1.1,1.8), and Q3 (AOR: 1.3; 95% CI: 1.1,1.6) height categories had higher odds of uncontrolled hypertension. PP was inversely associated and DBP was positively associated with height. Conclusions Although height was not associated with prevalence of hypertension, it had inverse association with uncontrolled hypertension. It was also significantly associated with DBP and PP among the individuals with untreated hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-021-00164-4.
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Das Gupta R, Talukder A, Haider SS, Al Kibria GM. Determinants of hypertension in Nepal using odds ratios and prevalence ratios: an analysis of the Demographic and Health Survey 2016. J Biosoc Sci 2021; 53:522-30. [PMID: 32611458 DOI: 10.1017/S0021932020000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This cross-sectional study investigated the factors associated with hypertension among Nepalese adults aged 18 years or above using data from the Nepal Demographic and Health Survey 2016. Prevalence ratios (PRs) and odds ratios (ORs) were obtained using log-binomial regression and logistic regression, respectively. Initially, unadjusted PRs and ORs were obtained. The variables that yielded a significance level below 0.2 in unadjusted analyses were included in the multivariable analysis. The overall prevalence of hypertension among the 13,393 participants (58% male and 61.2% urban) was 21.1% (n = 2827). In the adjusted analysis, those aged 30-49 years (adjusted PR [APR]: 3.1, 95% Confidence Interval (CI): 2.6, 3.7; adjusted OR [AOR]: 3.6, 95% CI: 2.9, 4.5), 50-69 years (APR: 5.3, 95% CI: 4.4, 6.6; AOR: 8.2, 95% CI: 6.4, 10.4) and ≥70 years (APR: 7.3, 95% CI: 5.8, 9.2; AOR: 13.6, 95% CI: 10.1, 18.3) were more likely to be hypertensive than younger participants aged 18-29 years. Males (APR: 1.3, 95% CI: 1.2, 1.4; AOR: 1.5, 95% CI: 1.3, 1.7), overweight/obese participants (APR: 1.8, 95% CI: 1.7, 2.0; AOR: 2.4, 95% CI: 2.2, 2.8) and those in the richest wealth quintile (APR: 1.3, 95% CI: 1.1, 1.5; AOR: 1.5, 95% CI: 1.1, 1.9) had higher prevalences and odds of hypertension than their female, normal weight/underweight and poorest wealth quintile counterparts, respectively. Those residing in Province 4 (APR: 1.2, 95% CI: 1.0, 1.5; AOR: 1.4, 95% CI: 1.1, 1.8) and Province 5 (APR: 1.2, 95% CI: 1.0, 1.4; AOR: 1.3, 95% CI: 1.1, 1.7) were more likely to be hypertensive than those residing in Province 1. The point estimate was inflated more in magnitude by ORs than by PRs, but the direction of association remained the same. Public health programmes in Nepal aimed at preventing hypertension should raise awareness among the elderly, males, individuals in the richest wealth quintile and the residents of Provinces 4 and 5.
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Talukder A, Ali M. Assessing the true association between hypertension status and stature of individuals in Bangladesh: propensity score analysis. J Hum Hypertens 2021; 35:250-6. [PMID: 32203075 DOI: 10.1038/s41371-020-0328-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/09/2022]
Abstract
Inconsistent evidence is found in the literature regarding the association between individuals' stature and hypertension status. In this study, an attempt has been made to investigate the true association between height and occurrence of hypertension. For analysis purpose, this study considers Bangladesh Demographic and Health Survey (BDHS) 2011 data obtained from an observational study. By dividing height (tall/normal/short) based on 25th and 75th percentile points separately for females and males, a binary logistic regression model was fitted to the weighted data, where weights were calculated from propensity scores (PS). From the PS-based weighted data, we did not find any significant association between height and hypertension (p > 0.05). Besides the respondent's height, logistic regression analyses of a balanced data set have revolved around some well-known factors that are associated with the occurrence of hypertension: gender of the respondent, higher wealth index status, as well as overweight. This study also found higher odds of occurring hypertension among the residents of Khulna and Rangpur divisions, whereas lower likelihood of hypertension is reported for the individual living in Chittagong and Sylhet districts. The findings of this paper indicate that human stature is not a risk factor for hypertension. Apart from height, this study uncovers some important risk factors for developing hypertension. By considering these factors, awareness should be raised among male, wealthier, and overweighted individuals in Bangladesh. However, why the prevalence of hypertension is higher in Khulna and Rangpur, as well as lower in Chittagong and Sylhet, demands further research.
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