Factors Responsible for Elevated Blood Pressure Among Bangladeshi Adults

regular physical activity, change of lifestyle towards healthy and controlled food and proper medication can reduce the body weight and ultimately can control the elevated blood pressure [22]. In almost all studies mentioned above some socioeconomic variables were identified as the risk factors for hypertension. But, all levels of a particular variable may not be equally responsible in enhancing the blood pressure to a co-morbidity state. In this paper, an attempt was made to identify some socioeconomic variables including a particular level of the variables responsible for elevated blood pressure among Bangladeshi adults. Methodology The present study was based on data collected from 900 adults of ages 18 years and above residing in both urban and rural areas of Bangladesh by some doctors and nurses during the academic session 2016-17 when they doing their M.P.H. degree. The ABSTRACT The objective of the present work was to identify the socioeconomic variables responsible for elevated blood pressure among Bangladeshi urban and rural adults of 18 years and above. Accordingly, 900 respondents were interviewed by some doctors and nurses from and nearby their working places and analysis was done using the data collected from those adults. During investigation, the blood pressure (mmHg) of the respondents were recorded and found that 2.9% adults had elevated blood pressure [ B.P.≥ 140/90]. This group was more likely among rural, non-Muslim, single, aged, illiterate, rich and diabetic people. The problem was also more likely in retired persons and process food consumers. The most responsible variable for elevated blood pressure was occupation followed by smoking habit, sedentary activity, gender, and family expenditure. These variables were identified by factor analysis.

respondents were interviewed from and near by the working places of the investigators according to a convenient sampling plan. Data were collected through a pre-designed and pre-tested questionnaire. The information collected were on residence, religion, gender, age, body weight, height, marital status, education, occupation, family income and expenditure of the respondents.
Beside these, the other information were on physical working condition of the respondents, their food habit, smoking habit, ) and obese (if BMI ≥ 27.5 ) [23,24]. They were also divided into 2 groups according to their blood pressure level (mmHg). One group was identified as respondents of non-elevated blood pressure and another group had elevated blood pressure (BP ≥ 140/90) [18,25].
The grouping was done according to the objective of the study. For the study, association of any of the socioeconomic characteristics with level of blood pressure was examined. Significant association was decided if probability of any Chi-square test statistic used for observing association ≤ 0.05. Irrespective of significant or insignificant association, the risk ratio [R.R] in favor of a higher group (in percentage) of adults of elevated blood pressure or nonelevated blood pressure was computed along with 95% confidence interval of R.R. The identification of responsible variable for elevated blood pressure was done by factor analysis, where the most responsible variable was detected by the highest absolute value of the factor loading [26][27][28].

Result
It was found that 2.9% adults had elevated blood pressure. This percentage among rural people (18.6%) was 3.6 and it was higher compared to the corresponding percentage (2.7) in urban adults (81.4%; Table 1

Factor Analysis
The variables included for factor analysis were residence, religion, gender, age, education, occupation, working habit, family income and expenditure, habit of taking can food, smoking habit,  (Table 2). From the analysis it was observed that the most responsible factor for elevated blood pressure was occupation followed by smoking habit, sedentary activity gender and family expenditure.

Discussion
One of the most responsible cause of cardiovascular diseases is elevated blood pressure [4,8,15,25]. It prevails largely in adults of 18 years and above irrespective of sex and residential variation [2,3,4,7,17,19]. It is measured by the level of blood pressure and there are different guidelines for the measurement of elevated blood pressure [10,18,25]. In some studies, it was mentioned that if the blood pressure of a person is ≥ 140 / 90 mmHg, he or she is considered as a patient of elevated blood pressure or hypertension [8,10,18,19]. Studies were also conducted to identify the social determinants of it in both home and abroad [1][2][3][4][5]7,9,[19][20][21][22].
The present study was conducted to identify some responsible variables for elevated blood pressure in Bangladeshi adults. For this, data were collected from 900 respondents of 18 years and above residing in both urban and rural areas.
The respondents were divided into two groups according to their blood pressure level. In one group there were 2.9% adults who were suffering from elevated blood pressure [18]. Non-prevalence of elevated blood pressure was noted in 97.1% respondents. These two groups were again classified according to different levels of socioeconomic characteristics. Association of prevalence of blood pressure with level of any social characteristic was investigated by Chi -square test and the chance of risk of elevated blood pressure in adults of a level of social characteristic was investigated by calculating risk ratio. According to the objective of the study the responsible socioeconomic variables were identified by factor analysis. The analysis indicated that occupation was the most responsible factor for elevated blood pressure and the chance of it was 2.13 times more among retired persons as in others. The next responsible variable was smoking habit, though the chance of prevalence of elevated blood pressure was similar among smokers and non-smokers. In earlier study, smoking habit was observed associated with hypertension [5].
The third responsible variable was sedentary activity and the chance of this health hazard was 5.96 times more in adults involved in sedentary activity as it was in others. The fourth responsible variable was gender and it was observed that females were slightly more exposed to this health hazard. The fifth responsible variable was family expenditure and chance of elevated blood pressure was 2.00 times more in adults spending highest amount of money as family expenditure as it was in others. Besides the above-mentioned variables, lower education, over age, level of body mass index, prevalence of diabetes and habit of taking process food were the risk factors for elevated blood pressure. This finding was similar as it was observed in other studies in home and abroad [ 3-5, 7, 9, 15, 19-23].

Conclusion
The study was conducted among 900 Bangladeshi urban and rural adults of 18 years and above with an objective of identifying some socioeconomic characteristics responsible for elevated blood pressure. Among 900 adults 2.9% were identified as patients of hypertension or elevated blood pressure [18,25]. This health hazard was observed significantly associated with age, education marital status, level of obesity, prevalence of diabetes sedentary activity and habit of taking process food. However, the risk of this health problem was more than double among currently single, diabetic, retired adults and adults of rich families. The chance of elevated blood pressure was more than four times in illiterate adults and in adults habituated in taking process food and involved in sedentary activity.
Due to upward movement of socioeconomic characteristic, the problem of change of food habit and involvement in sedentary activity and hence obesity and diabetes cannot be avoided. But people can be made aware of the health hazard arises from obesity, diabetes, sedentary activity, and elevated blood pressure. They can be encouraged Rural and urban social and health workers, government health service providers and medical practitioners can do a lot to encourage the people to follow the above steps.