Some Factors Related to High Blood Pressure in People 18

Thua Thien Hue in 2011 was 16.8% [14]. Chu Thi Thu Ha et al (2014), in people aged 25 - 64 in Hanoi in 2012 was 11.7% [19]. Tran Thi Mai Hoa (2014), in people aged 25 and over in Tan Phu district, Ca Mau province in 2014 was 17.2% [25]. Do Thi Phuong Ha et al (2015), in overweight and obese people (25 - 64 years old) in Vietnam in 2005 was 25.2% [98]. Nguyen Lan Viet et al (2008), in people aged 25 and over in 8 provinces/cities in 2008 was 25.1% [62]. Truong Thi Thuy Duong (2016), in people aged 18 and over in Ha Nam province in 2013, it was 24.4% [16]. Nguyen Thanh Binh (2017), in Khemer people (24 - 64 years old) in Tra Vinh province in 2015, it was 25.4% [1]. Do Thai Hoa and colleagues (2014), in people aged 40 - 59 in Dong Son district, Thanh Hoa province in 2013, it was 19.7% [26]. Dang Thi Nhan and colleagues (2014), in workers in the coastal areas of the North in 2013, it was 16.6% [42].

The prevalence of hypertension in our study results was lower than the survey results of people ≥ 25 years old in 8 provinces of Vietnam in 2015 which was 47.3% [68]. Hypertension in people aged 18 - 80 years old in Romania in 2014 was 40.41% [88].

The explanation for the difference in the rate of hypertension in our study results compared to the published research results above may be due to the different time/period of the study, different age of the subjects, different sample size and sampling method.

4.1.2. Some factors related to high blood pressure in people aged 18 - 69

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* Behavioral risk factors for hypertension:

- Smoking behavior: When smoking increases the concentration of catecholamine in the blood (this is a hormone that stimulates the body's sympathetic nervous system) and increases carbon monoxide, on the other hand, the increased concentration of nicotine in the blood causes vasoconstriction, causing hypertension, increasing heart rate leading to arrhythmia. The level of impact on the cardiovascular system increases with the level of smoking, that is, the more you smoke and the longer you smoke, the higher the risk of cardiovascular disease, including hypertension.

The research results show that the rate of subjects smoking is 18.2%, equivalent to the research results of Nguyen Ngoc Huy et al. (2021), in Cham people aged 18 and over in 11 communes of 4 provinces (Ninh Thuan, Binh Thuan, Binh Dinh and Phu Yen) in 2016 - 2017, the smoking rate was 18.2% [30]. But it is much lower than the research results of Pham The Xuyen (2019), in people aged 45 - 64 in Dien Bien province in 2014, the smoking rate was 44.9% (76.1% in men and 14.6% in women) [71]; Nguyen Thanh Binh (2017), in Khmer people in Tra Vinh province in 2015 - 2016, the smoking rate was 32.0% [1].

- Alcohol/beer drinking behavior: The habit of drinking alcohol/beer has caused harmful effects such as hypertension, lipid metabolism disorders, and blood sugar disorders. These are risk factors that cause cardiovascular complications for people who drink alcohol/beer. Excessive and long-term alcohol/beer drinking will cause hypertension, which in turn leads to other dangerous cardiovascular complications such as stroke, myocardial infarction, etc. People who drink too much alcohol/beer have blood pressure values 5 - 10 mmHg higher than others.

Standard alcohol intake for men and women: if 1 glass of alcohol is considered equivalent to 330 ml of beer (5%), 30 ml of spirits (40%), 120 ml of wine (11%) or 50 ml of aperitif (20%), the maximum amount of alcohol recommended for health benefits is: 2 glasses/day for men under 65 years old; 1 glass/day for men 65 years old and over; 1 glass/day for women of all ages. A person is identified as abusing alcohol/beer when the amount of alcohol/beer consumed is determined to be more than 1 standard unit of alcohol/day for women, more than 2 standard units of alcohol/day for men [27], [73], [132].

The research results showed that the rate of subjects who drank alcohol/beer was 24.9%, this rate was lower than the research results of Pham The Xuyen in Dien Bien district, Dien Bien province in 2014, the rate of drinking alcohol/beer was 54.2% [71]. But

higher than the research results of Nguyen Thanh Binh in Khmer people in Tra Vinh province (2015 - 2016), the rate of alcohol/beer abuse was 14.8% [1].

- The habit of regularly adding salt, salty spices or salty sauces to food: Diet has a direct impact on each person's body. If you eat properly and scientifically, your body will be healthier. On the contrary, an unreasonable and improper diet is like nurturing more pathogens in the body. In particular, the habit of eating salty foods needs to be eliminated because it can be harmful to health, especially increasing the risk of hypertension.

Salt is an indispensable seasoning in every person's daily meals. However, people who have a habit of eating salty foods or eating too much salt may face health risks. Salt contains sodium and chloride, which are two very good and important minerals for the body. Sodium helps regulate blood pressure, blood volume, muscle contraction and nerve function. Chloride is an electrolyte, which is essential for organs in the body. So it can be said that salt is very important for health.

However, many studies have shown that salt is the cause of hypertension. In countries with a high salt diet, the population has a higher rate of hypertension. When there is excess salt, the amount of fluid in the blood increases, causing hypertension, and the amount of salt accumulated in the blood vessel wall makes the blood vessel wall "harder", which is a favorable factor for hypertension. Therefore, you should not eat too much salt, eating a lot of salt regularly will lead to hypertension and is also the cause of potential heart attacks. Therefore, doctors recommend that patients with cardiovascular disease, including hypertension, should follow a less salty diet.

How to know if someone is eating too much salt. In fact, it is difficult to measure exactly how much salt each person consumes daily from foods. But there are questions to ask a person (subject) we are interested in to see if that person is eating too much salt or not such as: Do you always feel thirsty? Do you feel swollen feet, hands

No? Do you feel that food is not tasty and always bland? Do you often add salt, salty spices or salty sauces to your food? ... When the subject answers one of the above questions yes, it is a habit or behavior of eating a lot of salt (eating salty) and is at risk of hypertension.

The research results showed that the proportion of subjects who regularly added salt, salty spices or salty sauces to food was 60.9%, which was lower than the research results of Nguyen Thanh Binh (2017) on Khmer people in Tra Vinh province (2015 - 2016), the proportion of subjects eating salty foods was 89.4% [1]. But it was higher than the research results of Nguyen Ngoc Huy et al. (2021) on Cham people aged 18 and over in 4 provinces of the South Central Coast (2016 - 2017), the proportion of salty foods was 47.3% [30].

- Regarding the habit of consuming animal fat: The first "enemy" of people with hypertension is fat. Fat from animal fat, from meat as well as fat in the skin of poultry not only causes weight gain but is also an important factor contributing to atherosclerosis, leading to hypertension, heart disease, and stroke. Therefore, people with hypertension, instead of eating fatty foods, should eat dishes made from fish and seafood to both reduce fat and add unsaturated fatty acids, omega, and minerals that are beneficial for people with hypertension. Research results show that the rate of people with the habit of eating/consuming animal fat is 10.0%. This result is lower than the research results of Nguyen Thanh Binh (2017) in Tra Vinh province (2015 - 2016), the rate of eating a lot of animal fat is 16.4% [1]; According to a study by Nguyen Ngoc Huy et al. (2021) in 4 provinces of the South Central region (2016 - 2017), the proportion of Cham people eating a lot of animal fat was 15.9% [30].

- Regarding low physical activity or irregular physical activity: Many studies show that regular physical activity will help increase longevity, reduce the risk of disease and death. Regular physical activity or daily exercise will bring clear benefits in preventing hypertension, even in people with many high risk factors for this disease. In people with hypertension, regular physical activity at a light level and

Moderate exercise can also lower blood pressure. Exercise also reduces mortality in people with hypertension [136]. Physical activity such as exercise, walking or moderate physical activity suitable for one's health, regularly ≥ 30 minutes/day or ≥ 150 minutes/week is considered regular daily physical activity or > 600 MET/minute/week [108]. The study results showed that the rate of regular physical activity was not high (34.4%), this result was lower than the research results of Nguyen Ngoc Huy et al. (2021), the rate of regular physical activity of Cham people in the South Central region was 67.2% [30].

- Regarding monitoring the nutritional composition of daily meals: For people who do not have hypertension, to prevent hypertension, they should practice a healthy lifestyle early. Many studies show that maintaining an ideal weight, exercising regularly, a reasonable, healthy diet (low fat, lots of fruits, vegetables, tubers, nuts and low-fat dairy products, eating fish, skinless poultry, reducing salt intake, reducing fatty meat, canned food, fast food) will help reduce blood pressure numbers and maintain a normal, healthy blood pressure level.

For people with hypertension: Diet plays a very important role in controlling blood pressure. Therefore, in addition to taking daily blood pressure control medication, diet also needs to be focused on to quickly return blood pressure to normal levels. Accordingly, patients with hypertension need to follow the main principles of the "3 reductions" and "3 increases" diet: 3 reductions (reduce salt intake, reduce fat, reduce alcohol/beer consumption) and 3 increases (increase the use of foods rich in calcium, rich in potassium and rich in protective substances such as green vegetables, tubers, beans and fruits); build a "1 increase, 1 reduction and 1 quit" lifestyle: increase exercise, reduce stress and quit smoking. Thus, both people who do not have hypertension and people with hypertension need to monitor the nutritional composition of daily meals to adjust their diet appropriately in preventing hypertension and other non-communicable diseases. Research results show that the rate of monitoring the nutritional composition of daily meals is low (35.1%). Thus, people who do not regularly follow

The risk of hypertension among subjects who regularly monitored their daily nutritional composition was statistically significant (OR = 1.57; 95% CI: 1.19 - 2.22; p < 0.001).

- Body mass index (BMI): Medicine has proven that controlling BMI plays an important role in preventing hypertension. In particular, preventing obesity and overweight means that patients will also reduce the risk of other chronic non-communicable diseases such as diabetes, gout, etc. Therefore, BMI is a typical index, reflecting whether a person's weight is at an appropriate level or not. This index is calculated based on the correlation between weight and height. BMI ≥ 23 is considered overweight - obese [3].

Hypertension and overweight - obesity are inherently correlated. Overweight - obese people who are sedentary have a higher rate of hypertension and other non-communicable diseases than normal people. On the contrary, if hypertensive patients do not know how to control their BMI or weight, the possibility of serious complications is very high. Therefore, BMI is the basis for both doctors and patients to monitor weight and treat the disease most effectively. From the physician's perspective, BMI plays a role as an indicator in the process of diagnosing the risk of hypertension, as well as complications in people who already have hypertension. For hypertensive patients, monitoring and adjusting BMI is a simple, inexpensive and can be done at home way to adjust and control weight. Thanks to that, the treatment process and living with hypertension are also easier and more comfortable.

The study results showed that the overweight - obese group had a higher risk of hypertension than the non-overweight - obese group at a statistically significant level (OR = 1.98; 95% CI: 1.18 - 2.30; p < 0.001). A study in China (2015) showed that the risk of hypertension in the BMI ≥ 28 group was 3.13 times higher (OR = 3.13; 95% CI: 2.84 - 3.45) than in the group with BMI < 22 [122]. A

Research in Tan Phu district, Ho Chi Minh City (2011) showed that obesity causes

increased risk of hypertension 5.9 times [32]. From the above research results, it shows that there is a close relationship between overweight - obesity and hypertension.

- Diabetes: Diabetes and hypertension are two separate, independent non-communicable diseases but are closely related to each other. When a person has one of these two diseases, it is very likely that they will continue to have the other. Both diseases (hypertension and diabetes) progress silently and cause many dangerous complications. The incidence of diabetes and hypertension always fluctuate and increase with age; diabetic patients have a risk of hypertension twice as high as normal people. Diabetes can cause hypertension by 3 factors: reducing the elasticity of blood vessels, increasing blood circulation in the body and changing the way the body manages insulin.

Thus, diabetes and hypertension have a close relationship. People with hypertension make diabetes develop faster, easily leading to diabetic complications. On the contrary, diabetes causes blood pressure to increase rapidly, making the rate of cardiovascular disease and stroke due to cardiovascular disease increase about 2 - 3 times compared to people with hypertension without diabetes.

Hypertension associated with diabetes can cause diabetic patients to develop complications faster and increase mortality. The reason is that hypertension obstructs blood flow to the kidneys (affecting diabetes); causing retinal complications and blindness. In addition, drugs to treat hypertension such as diuretics have the side effect of increasing blood glucose levels. Therefore, diabetic patients with hypertension are always given priority for treatment to reduce hypertension and vice versa, hypertensive patients with diabetes are always given priority for treatment to control blood glucose early at < 7.0 mmol/l (fasting) and ≤ 9.0 mmol/l (after meals) [5].

When a person has one of the two chronic non-communicable diseases above, the patient will encounter many difficulties in daily life because both diseases greatly affect the patient's health and can cause serious complications that threaten the patient's life. If a patient has both hypertension and diabetes at the same time, it will accelerate the process of atherosclerosis.

In patients with hypertension and diabetes, there are often 4 factors that cause atherosclerosis: hypertension, diabetes, dyslipidemia, overweight - obesity. These 4 factors interact with each other and are called "metabolic syndrome". The risk of diabetes and hypertension also causing cardiovascular disease and cerebrovascular disease is 6 - 7 times higher than that of normal people.

The study results showed that the rate of diabetic patients with hypertension was quite high (75.0%) and the diabetic group had a higher risk of hypertension than the non-diabetic group at a statistically significant level (OR = 6.03; 95% CI: 3.72 - 9.21; p < 0.001).

- Hypercholesterolemia factor: Dyslipidemia or hypercholesterolemia in particular is very common in hypertensive patients, and can occur before or after hypertension. Dyslipidemia causes atherosclerosis. Many studies have shown that dyslipidemia in hypertensive patients increases the risk of death from stroke and cardiovascular disease. Dyslipidemia is characterized by increased blood cholesterol, including: increased total cholesterol, increased triglycerides, increased LDL-C and decreased HDL-C. Cholesterol, triglycerides, LDL-C are bad cholesterol, the culprits of atherosclerosis; on the contrary, HDL-C is good cholesterol that protects the cardiovascular system. When HDL-C is reduced, it will have a negative effect on the cardiovascular system. Cholesterol is a type of fat produced by liver cells and partly absorbed from food. Cholesterol is essential for cell membrane structure, hormone balance in the body and vitamin production. However, excess cholesterol in the blood will cause atherosclerosis, increasing the risk of death from coronary artery disease and stroke.

The study results showed that the rate of patients with hypercholesterolemia and hypertension was quite high (64.6%) and the group of subjects with hypercholesterolemia had a higher risk of hypertension than the group without hypercholesterolemia at a statistically significant level (OR = 4.81; 95% CI: 2.98 - 7.35; p < 0.001). Truong Khanh Ly and colleagues (2007) also showed a close relationship between dyslipidemia and hypertension [32].

* On the relationship between some personal characteristics and hypertension:

Some Factors Related to High Blood Pressure in People 18 - 69 Years Old

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