Identifying Factors Associated With Hypertension Using Structural Equation Modeling: Evidence from a Large Kurdish Cohort Study in Iran

Background: Identifying the risk factors leading to hypertension can help explain why some populations are at a greater risk for developing hypertension than others. The present study seeks to identify the causal paths among the risk factors of hypertension in 35- to 65-year-old participants in western Iran. Methods: The secondary analysis was conducted using the data obtained in the recruitment stage of Ravansar Non-Communicable Disease (RaNCD) cohort. Each of the latent variables were confirmed by confirmatory factor analysis. Using Structural Equation Modeling (SEM), we assessed the direct and indirect effects of the risk factors associated with hypertension. Results: Socioeconomic status (SES), physical activity, lipid profile, obesity, Diabetes and family history of hypertension had a diverse impact on the blood pressure, directly and (or) indirectly. When investigating the latent and observers risk factors and the interrelations between different risk factors, The standardized total effect (the sum of direct and indirect effects, β t ) of SES, physical activity, lipid profile, obesity, on the blood pressure was( -0.09 vs -0.14), (-0.04 vs -0.04), (0.13 vs 0.13), (0.24 vs 0.15) in men and women respectively. Diabetes had a direct relationship with the blood pressure in women (0.03). Conclusion: With regard to control of high blood pressure, public health interventions must target obesity,SES, lifestyle and nutritional factors such as hyperlipidemia and hyperglycemia in Iranian population