Relationship between pulse pressure and body mass index in active-duty Royal Thai Army personnel in Thailand

Abstract

Background: Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few studies. However, the findings were inconsistent. Therefore, the aim of the present study is to identify the association between elevated PP and BMI using a large sample of active-duty Royal Thai Army (RTA) personnel.

Methods: A cross-sectional study was conducted through the use of the dataset obtained from the annual health examination database of RTA personnel in Thailand in 2022. BMI 25.0-29.9 kg/m² was classified as obesity I, whereas BMI ≥ 30.0 kg/m² was classified as obesity II. Elevated PP was defined as PP ≥ 50 mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI.

Results: A total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4 ± 3.8 kg/m², while the average PP was 50.1 ± 11.2 mmHg. Compared to individuals with normal weight, the [Formula: see text] coefficients of PP and BMI were 1.38 (95% CI: 1.15-1.60) and 2.57 (95% CI: 2.25-2.88) in individuals with obesity I and obesity II, respectively. Effect modification by high blood pressure (BP) on the association between elevated PP and BMI was observed. Among participants with normal BP, in comparison with BMI of 18.5-22.9 kg/m², the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19-1.28) and 1.41 (95% CI: 1.35-1.48) in those with obesity I and obesity II, respectively. Meanwhile, among individuals with high BP, the adjusted PR for elevated PP was 1.05 (95% CI: 1.01-1.08) and 1.09 (95% CI: 1.06-1.13) in those with obesity I and obesity II, respectively.

Conclusion: PP was positively associated with BMI in active-duty RTA personnel. High BP was the modifier of the association between PP and BMI. A weaker association between elevated PP and BMI was observed among RTA personnel with high BP.

Keywords: Body mass index; High blood pressure; Pulse pressure; Royal Thai Army; Thailand.

Fig. 1

Flowchart of study

Fig. 2

Average adjusted prediction of mean pulse pressure (mmHg) and 95% CI, by body mass index categories. A Average adjusted prediction of mean pulse pressure among overall RTA personnel, adjusting for high blood pressure, sex, age, regions, regular exercise, smoking status, alcohol use, high total cholesterol, high fasting plasma glucose. B Average adjusted prediction of mean pulse pressure among RTA personnel with normal blood pressure, adjusting for sex, age, regions, regular exercise, smoking status, alcohol use, high total cholesterol, high fasting plasma glucose. C Average adjusted prediction of mean pulse pressure among RTA personnel with high blood pressure, adjusting for sex, age, regions, regular exercise, smoking status, alcohol use, high total cholesterol, high fasting plasma glucose

Fig. 3

Spline curve of body mass index for the average adjusted prediction of prevalence of elevated pulse pressure ($\ge$ 50 mmHg) and 95% CI, by blood pressure groups

Fig. 4

Average adjusted prediction of the prevalence of elevated pulse pressure ($\ge$ 50 mmHg) and 95% CI, by body mass index categories. A Average adjusted prediction of prevalence of elevated pulse pressure ($\ge$ 50 mmHg) among overall RTA personnel, adjusting for sex, age, regions, regular exercise, smoking status, alcohol use, high total cholesterol, high fasting plasma glucose, and high blood pressure. B Average adjusted prediction of prevalence of elevated pulse pressure ($\ge$ 50 mmHg) among RTA personnel with normal blood pressure, adjusting for sex, age, regions, regular exercise, smoking status, alcohol use, high total cholesterol, and high fasting plasma glucose. C Average adjusted prediction of prevalence of elevated pulse pressure ($\ge$ 50 mmHg) among RTA personnel with high blood pressure, adjusting for sex, age, regions, regular exercise, smoking status, alcohol use, high total cholesterol, and high fasting plasma glucose