3.1 Background characteristics of the study participants
Figure 1 displayed the rate of having diabetes and hypertension. Among 6,965 respondents, 18.9 percent diabetes respondents were hypertension, on the contrarily, 13 percent diabetes respondents were non-hypertension. Therefore, the rate of having hypertension among diabetes respondents was higher compared to non-hypertension respondents.
The background characteristics of the study participants were presented in Table 2. The average age of the participants was 51.04 12.731. More than half (51.5 percent) of the participants were female and 48.5 percent were male. About 84.2 percent participants were married with having no education and they were physically inactive. Most of the respondents were taken from rural area and belong to richest wealth index quintile. Based on the BMI, 17.1 percent respondents were underweight, 56.5 percent normal and 26.4 percent overweight/obese. With regard to diabetes status as measured by FPG, 15.0 percent participants were diabetic, and 85.0 percent non-diabetic. The majority of the respondents (78.0 percent) were nonsmoker and having 4-6 family members. Table 2 showed that 34.7 percent participants were hypertension. It was also observed that 59.2 percent participants having age range years were higher hypertensive compared with the age ranges 35-49 years, and the association was statistically significant (p-value<0.01). Female respondent was more likely to having hypertension than male. The association between sex and hypertension was significantly significant. A total of three-fourth (78.9 percent) hypertension respondents were married. Regarding to the education level, more than one-third (38.7 percent) hypertension respondents were no education, (30.1 percent) primary education, (20.5%), secondary education, and (10.7 percent) higher education and their association was statistically significant.
Table 2. Background characteristics of the study participants
Factors
|
Overall,
n (%)
|
Hypertension status
|
-Value
|
p-value1
|
Hypertension, n (%)
|
No-hypertension, n (%)
|
Overall
|
|
2415(34.7)
|
4550(65.3)
|
|
|
Age
|
|
|
|
184.404
|
<0.001
|
35-49 years
|
3618(51.9)
|
985(40.8)
|
2633(57.9)
|
|
|
years
|
3347(48.1)
|
1430(59.2)
|
1917(42.1)
|
|
|
Sex
|
|
|
|
29.916
|
<0.001
|
Male
|
3376(48.5)
|
1062(44.0)
|
2314(50.9)
|
|
|
Female
|
3589(51.5)
|
1353(56.0)
|
2236(49.1)
|
|
|
Marital status
|
|
|
|
90.085
|
<0.001
|
Never married
|
24(0.30)
|
5(0.20)
|
19(0.40)
|
|
|
Married
|
5863(84.2)
|
1905(78.9)
|
3958(87.0)
|
|
|
Widowed
|
965(13.9)
|
463(19.2)
|
502(11.0)
|
|
|
Divorced
|
113(1.60)
|
42(1.70)
|
71(1.60)
|
|
|
Education level
|
|
|
|
9.087
|
0.028
|
No education
|
2678(38.4)
|
934(38.7)
|
1744(38.3)
|
|
|
Primary
|
2242(32.2)
|
728(30.1)
|
1514(33.3)
|
|
|
Secondary
|
1349(19.4)
|
494(20.5)
|
855(18.8)
|
|
|
Higher
|
696(10.0)
|
259(10.7)
|
437(9.60)
|
|
|
Working status
|
|
|
|
88.232
|
<0.001
|
No
|
2385(34.2)
|
1004(41.6)
|
1381(30.4)
|
|
|
Yes
|
4580(65.8)
|
1411(58.4)
|
3169(69.6)
|
|
|
Physical activity
|
|
|
|
89.656
|
<0.001
|
Inactive
|
4021(57.7)
|
1580(65.4)
|
2441(53.6)
|
|
|
Active
|
2944(42.3)
|
835(34.6)
|
2109(46.4)
|
|
|
Region
|
|
|
|
26.184
|
<0.001
|
Barisal
|
760(10.9)
|
286(11.8)
|
474(10.4)
|
|
|
Chattogram
|
889(12.8)
|
318(13.2)
|
571(12.5)
|
|
|
Dhaka
|
872(12.5)
|
300(12.4)
|
572(12.6)
|
|
|
Khulna
|
1043(15.0)
|
367(15.2)
|
676(14.9)
|
|
|
Mymensingh
|
817(11.7)
|
236(9.80)
|
581(12.8)
|
|
|
Rajshahi
|
890(12.8)
|
321(13.3)
|
579(12.5)
|
|
|
Rangpur
|
922(13.2)
|
350(14.5)
|
572(12.6)
|
|
|
Sylhet
|
772(11.1)
|
237(9.80)
|
535(11.8)
|
|
|
Residence
|
|
|
|
6.459
|
0.011
|
Urban
|
2411(34.6)
|
884(36.6)
|
1527(33.6)
|
|
|
Rural
|
4554(65.4)
|
1531(63.4)
|
3023(66.4)
|
|
|
Wealth index
|
|
|
|
71.002
|
<0.001
|
Poorest
|
1391(20.0)
|
409(16.9)
|
982(21.6)
|
|
|
poorer
|
1331(19.1)
|
397916.4)
|
934(20.4)
|
|
|
Middle
|
1372(19.7)
|
474(19.6)
|
898(19.7)
|
|
|
Richer
|
1299(18.7)
|
473(19.6)
|
826(18.2)
|
|
|
Richest
|
1572(22.6)
|
662(27.4)
|
910(20)
|
|
|
Family size
|
|
|
|
15.667
|
<0.001
|
1-3
|
1547(22.2)
|
594(24.6)
|
953(20.9)
|
|
|
4-6
|
3814(54.8)
|
1252(51.8)
|
2562(56.3)
|
|
|
7 and 7+
|
1604(23.0)
|
569(23.6)
|
1035(22.7)
|
|
|
Smoking status
|
|
|
|
5.386
|
0.020
|
No
|
5436(78.0)
|
1923(79.6)
|
3513(77.2)
|
|
|
Yes
|
1529(22.0)
|
492(20.40
|
1037(22.8)
|
|
|
BMI(Kg/m2)
|
|
|
|
184.185
|
<0.001
|
Underweight
|
1169(17.1)
|
282(11.8)
|
887(19.9)
|
|
|
Normal
|
3970(56.5)
|
1253(52.6)
|
2617(58.6)
|
|
|
Overweight/Obese
|
1811(26.4)
|
848(35.6)
|
963(21.6)
|
|
|
Diabetes
|
|
|
|
42.894
|
<0.001
|
No
|
6918(85.0)
|
1959(81.1)
|
3959(87.0)
|
|
|
Yes
|
1047(15.0)
|
456(18.9)
|
591(13.0)
|
|
|
About 58.4 percent hypertension respondents having working status and (34.6 percent) were physical active. Working status and physical activity were also significantly associated with hypertension. It was observed that the maximum number of the hypertension respondents taken from rural area and having richest wealth index quintile. The association between residence, wealth index and hypertension were statistically significant. Most of the hypertension respondents were non-smoker than their counterparts and the association was also significant. The higher percentage (51.8 percent) of respondent having hypertension those families whose family members 4 to 6 and the association between family size and hypertension were statistically significant. Among the hypertensive respondents, only 11.8 percent was underweight, 52.6 percent normal and 35.6 percent overweight/ obese and their association was statistically significant. According to FPG, 18.9 percent hypertension respondents having diabetes compared to their counterpart and the association between diabetes and hypertension was statistically significant. Table 2 also represented that region, residence, and wealth index were significantly associated with hypertension.
3.2 Association between different selected factors and hypertension by age groups
Table 3 represented the association between different selected factors and hypertension by age groups (35-49 and 50 years). It was observed that sex, education level, working status, physical activity, wealth index, family size, smoking status, BMI, and diabetes were significantly associated with hypertension while the rest of the factors marital status, region, residence were statistically insignificant for age group 35-49 years. On the contrary, it was noted that sex, marital status, education level, working status, physical activity, region, residence, wealth index, smoking status, BMI, and diabetes were significantly associated with hypertension whereas family size was insignificantly associated with hypertension for the respondents who age were 50 years.
Table 3. Association between selected factors and hypertension by age groups
Factors
|
|
35-49 years
|
|
>=50 years
|
Overall,
n (%)
|
Hypertension
, n(%)
|
-Value
|
p-
value1
|
Overall,
n (%)
|
Hypertension
, n (%)
|
-Value
|
p-
value1
|
Sex
|
|
|
37.381
|
<0.001
|
|
|
9.773
|
0.002
|
Male
|
1640(45.3)
|
365(37.1)
|
|
|
1736(51.9)
|
697(48.7)
|
|
|
Female
|
1978(54.7)
|
620(62.9)
|
|
|
1611(48.1)
|
733(51.3)
|
|
|
Marital status
|
|
|
2.540
|
0.468
|
|
|
32.114
|
<0.001
|
Never married
|
20(0.60)
|
3(0.30)
|
|
|
4(0.10)
|
2(0.10)
|
|
|
Married
|
3389(93.7)
|
919(93.3)
|
|
|
2474(73.9)
|
986(69.0)
|
|
|
Widowed
|
146(4.00)
|
45(4.60)
|
|
|
819(24.5)
|
418(29.2)
|
|
|
Divorced
|
63(1.70)
|
18(1.80)
|
|
|
50(1.50)
|
24(1.70)
|
|
|
Education level
|
|
|
11.034
|
0.010
|
|
|
12.026
|
0.007
|
No education
|
1031(28.5)
|
250(25.4)
|
|
|
1647(49.2)
|
684(47.8)
|
|
|
Primary
|
1295(35.8)
|
343(34.8)
|
|
|
947(28.3)
|
385(26.9)
|
|
|
Secondary
|
835(23.1)
|
254(25.8)
|
|
|
514(15.4)
|
240(16.8)
|
|
|
Higher
|
457(12.6)
|
138(14.0)
|
|
|
239(7.10)
|
121(8.50)
|
|
|
Working status
|
|
|
13.067
|
<0.001
|
|
|
33.454
|
<0.001
|
No
|
897(24.8)
|
286(29.0)
|
|
|
1488(44.5)
|
718(50.2)
|
|
|
Yes
|
2721(75.2)
|
699(71.0)
|
|
|
1869(55.5)
|
712(49.8)
|
|
|
Physical activity
|
|
|
24.126
|
<0.001
|
|
|
45.473
|
<0.001
|
Inactive
|
1915(52.9)
|
587(59.6)
|
|
|
2106(62.0)
|
993(69.4)
|
|
|
Active
|
1703(47.1)
|
398(40.4)
|
|
|
1241(37.1)
|
437(30.6)
|
|
|
Region
|
|
|
14.086
|
0.050
|
|
|
20.702
|
0.004
|
Barisal
|
383(10.6)
|
108(11.0)
|
|
|
377(11.3)
|
178(12.4)
|
|
|
Chattogram
|
453(12.5)
|
127(12.9)
|
|
|
436(13.0)
|
191(13.4)
|
|
|
Dhaka
|
490(13.5)
|
138(14.0)
|
|
|
382(11.4)
|
162(13.3)
|
|
|
Khulna
|
548(15.1)
|
152(15.4)
|
|
|
495(14.8)
|
215(15.0)
|
|
|
Mymensingh
|
377(10.4)
|
87(8.80)
|
|
|
440(13.1)
|
149(10.4)
|
|
|
Rajshahi
|
469(13.0)
|
128(13.0)
|
|
|
421(12.6)
|
173(13.5)
|
|
|
Rangpur
|
483(13.3)
|
153(15.5)
|
|
|
439(13.1)
|
197(13.8)
|
|
|
Sylhet
|
415(11.5)
|
92(9.3)
|
|
|
357(10.7)
|
145(10.1)
|
|
|
Residence
|
|
|
2.800
|
0.094
|
|
|
9.109
|
0.003
|
Urban
|
1342(37.1)
|
387(39.3)
|
|
|
1069(31.9)
|
497(34.8)
|
|
|
Rural
|
2276(62.9)
|
598(60.7)
|
|
|
2278(68.1)
|
933(65.2)
|
|
|
Wealth index
|
|
|
49.864
|
<0.001
|
|
|
31.990
|
<0.001
|
Poorest
|
714(19.7)
|
147(14.9)
|
|
|
677(20.2)
|
262(18.3)
|
|
|
Poorer
|
695(19.2)
|
150(15.2)
|
|
|
636(19.0)
|
247(17.3)
|
|
|
Middle
|
698(19.3)
|
201(20.4)
|
|
|
674(20.1)
|
273(19.1)
|
|
|
Richer
|
678(18.7)
|
204(20.7)
|
|
|
621(18.6)
|
269(18.8)
|
|
|
Richest
|
833(23.0)
|
283(28.7)
|
|
|
739(22.1)
|
379(26.5)
|
|
|
Family size
|
|
|
10.381
|
0.006
|
|
|
0.860
|
0.650
|
1-3
|
771(19.9)
|
230(23.4)
|
|
|
826(24.7)
|
364(25.5)
|
|
|
4-6
|
2164(59.8)
|
557(56.5)
|
|
|
1650(49.3)
|
695(48.6)
|
|
|
7 and 7+
|
733(20.3)
|
198(20.1)
|
|
|
871(26.0)
|
371(25.9)
|
|
|
Smoking status
|
|
|
7.401
|
0.007
|
|
|
6.681
|
0.010
|
No
|
2968(82.0)
|
836(84.9)
|
|
|
2468(73.7)
|
1087(76.0)
|
|
|
Yes
|
650(18.0)
|
149(15.1)
|
|
|
879(26.3)
|
343(24.0)
|
|
|
BMI(Kg/m2)
|
|
|
181.845
|
<0.001
|
|
|
95.664
|
<0.001
|
Underweight
|
418(11.8)
|
46(4.70)
|
|
|
751(22.8)
|
236(16.7)
|
|
|
Normal
|
1985(55.9)
|
454(46.9)
|
|
|
1885(57.1)
|
799(56.5)
|
|
|
Overweight/Obese
|
1148(32.3)
|
469(48.4)
|
|
|
663(20.1)
|
379(26.8)
|
|
|
Diabetes
|
|
|
33.020
|
<0.001
|
|
|
9.225
|
0.002
|
No
|
3125(86.4)
|
798(81.0)
|
|
|
2793(83.4)
|
1161(81.2)
|
|
|
Yes
|
493(13.6)
|
181(19.0)
|
|
|
554(16.6)
|
269(18.8)
|
|
|
3.3 Effect of diabetes on hypertension
The main purpose of this study was to investigate the effect of diabetes on hypertension. For the study purpose, we considered two logistic regression models, namely Model-I and Model-II. In Model-I, only diabetes was treated as an explanatory variable and hypertension as outcome variable. We calculated the crude odds ratio (COR) along with 95% confidence interval from Model-I. In Model II, we adjusted the significant factors as age, sex, marital status, education level, working status, physical activity, region, residence, wealth index, family size, smoking status, BMI which were statistically significant in Table 2. The result of two logistic regression models was presented in Table 4. From Model-I, it was observed that the factor of diabetes showed a significant impact on hypertension. The COR was 1.599 (95% CI of COR: 1.364, 1.782) that means the diabetic respondents were 1.599 times higher risk of hypertension than non-diabetic respondents. In Model II, the AOR was 1.280 (95% CI of AOR: 1.107, 1.479; p-value: 0.001) implies that the diabetic respondents were 1.280 times higher risk of hypertension than non-diabetic respondents after adjusting the significant risk factors. So, we may conclude that diabetes had a significant effect on hypertension.
Table 4. Effect of diabetes on hypertension
Factors
|
Model I
|
Model II
|
COR
|
p-value
|
95% CI of COR
|
AOR
|
p-value
|
95% CI of AOR
|
Lower
|
Upper
|
Lower
|
Upper
|
Diabetes
|
|
|
|
|
|
|
|
|
No (Ref)
|
1.000
|
-
|
-
|
-
|
1.000
|
-
|
-
|
-
|
Yes
|
1.599
|
0.000
|
1.364
|
1.782
|
1.280
|
0.001
|
1.107
|
1.479
|
COR: Crude odds ratio; p-value: probability value; AOR: adjusted odds ratio. Age, sex, marital status, education level, working status, physical activity, region, residence, wealth index, family size, smoking status, and BMI were adjusted in Model II.
3.4 Effect of diabetes on hypertension by age groups (35-49 and 50 years)
The effect of diabetes on hypertension by age groups 35-49 and 50 years was presented in Table 5. Model-I showed that diabetes had a significant impact on hypertension for age groups as 35-49, and 50 years. It was also noted that the COR was higher (COR: 1.768) for the respondents whose age group 35-49 years. That means the diabetic respondents whose age were 35-49 years had the higher risk of hypertension compared to the respondents who was the age 50 years. We adjusted the factors in Model-II which were showed statistically significant at 5% level of significance in Table 3. Model-II revealed that the factor of diabetes was also a significant effect on hypertension whose age was 35-49 years.
Table 5. Effect of diabetes on hypertension by age groups as 35-49 and 50 years
Age (years)
|
Factors
|
Model I
|
Model II
|
COR
|
p- value
|
95% CI of COR
|
AOR
|
p- value
|
95% CI of AOR
|
Lower
|
Upper
|
Lower
|
Upper
|
35-49
|
Diabetes
|
|
|
|
|
|
|
|
|
No (Ref)
|
1.000
|
-
|
-
|
-
|
1.000
|
-
|
-
|
-
|
Yes
|
1.782
|
0.000
|
1.461
|
2.174
|
1.462
|
0.000
|
1.182
|
1.807
|
50
|
Diabetes
|
|
|
|
|
|
|
|
|
No (Ref)
|
1.000
|
-
|
-
|
-
|
1.000
|
-
|
-
|
-
|
Yes
|
1.327
|
.002
|
1.105
|
1.593
|
1.142
|
0.184
|
0.939
|
1.390
|
COR: Crude odds ratio; p-value: probability value; AOR: adjusted odds ratio. Sex, education level, working status, physical activity, wealth Index, family size, smoking status, and BMI were adjusted in Model II.at age group 35-49 years; Sex, marital status, education level, working status, physical activity, region, residence, wealth Index, family size, smoking status, and BMI were adjusted in Model II at age group ≥ 50 years.