Analysis of Repeated Measurements of Blood Pressure with Linear Mixed Model
Date Issued
2011
Date
2011
Author(s)
Huang, Ya-Ping
Abstract
Purpose:Hypertension has been recognized as a major risk factor for stroke and cardiovascular disease. Its prevention becomes the core subject of public health, particularly life-style modification offered for patients with pre-hypertension pursuant to JNC7 guideline in order to reduce the incidence of hypertension. Very few studies revealed the dynamic change of blood pressure from normal status to hypertension based on longitudinal repeated measurements of blood pressure. Therefore, we aimed to assess the risk factors responsible for the changes of blood pressure based on a longitudinal follow-up cohort on screening for multiple diseases.
Methods:The data with repeated measurement for analysis was derived from a Taiwanese Community-based Integrated Screening （CIS） program with 10-year longitudinal follow-up. A longitudinal and prospective cohort follow-up design was conducted in this study. After excluding the prevalent hypertension cases at first screen, we enrolled a total of 56,227 participants without hypertension including normal and pre-hypertension groups to collect the information on the measurement of systolic and diabolic blood pressure followed with periodical repeated screens. The additional information on repeated characteristics was also collected including fasting blood sugar, total cholesterol, triglyceride, high density lipoprotein. The baseline characteristics including age, gender, body mass index, education level, life styles including smoking, drinking, and betel nut chewing, personal disease history were also collected in this study. With repeated measurement data, a series of linear mixed models were applied to assess the risk of blood pressure progress or change in normal blood pressure and pre-hypertension groups. Proportional hazard regression model was also used to assess the risk of hypertension development in same cohort with long-term follow up.
Results:Compared with normal blood pressure group, pre-hypertensive subjects had higher risk of incident hypertension, and had tendency to decrease blood pressure while normal blood pressure group tended to increase blood pressure mildly. The diastolic blood pressure showed less change of blood pressure and less incidence of new developed hypertension compared with systolic blood pressure. This result revealed that baseline SBP, age, gender, body mass index （BMI）, fasting blood sugar, cholesterol, triglyceride, high density lipoprotein, education level, smoking and drinking were risk factors for blood pressure change. The different risk factors have been demonstrated between normal blood pressure and pre-hypertension group.
Conclusion The risk factors for blood pressure progress and hypertension development were revealed in this study. The result was very useful to apply the life-style modification based on the light of risk factors from our findings to reduce the incidence of hypertension in terms of population-based hypertension preventive approach.
Subjects
Blood pressure
repeated measurement
prehypertension
linear mixed model
SDGs
Type
thesis
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