Path Analysis on the Biopsychosocial Factors Associated with Hypertension

Febry Istyanto, Ambar Mudigdo, Setyo Sri Rahardjo


Background: Hypertension is a non-communicable disease which may lead to premature death and disability. This study aimed to determine the biopsychosocial factors associated with the risk of hypertension.

Subjects and Method: This was an analytic observational study with a case-control design. This study was conducted at Dr. Moewardi Hospital, from September to November 2018. A sample of 225 patients was selected by fixed disease sampling. The dependent variable was hypertension. The independent variables were anxiety, stress, quality of sleep, body mass index (BMI), physical activity, vegetables and fruit, coffee drink, and soft drink consumption. Blood pressure was measured by sphygmomanometer. Body weight was measured by scale. Body height was measured by microtoise. The other data were collected by questionnaire and analyzed by path analysis.

Results: Hypertension directly increased with anxiety (b= 0.26; 95%CI= 0.02to 0.51; p= 0.037), stress (b= 0.28; 95%CI= 0.04 to 0.53; p= 0.022), poor quality of sleep (b= 0.46; 95%CI= 0.06 to 0.87; p= 0.026), BMI (b= 0.68; 95%CI= 0.051 to 1.31; p= 0.034), coffee drink consumption (b= 1.31; 95%CI= 0.17 to 2.46; p= 0.024), and soft drink consumption (b= 0.38; 95%CI= 0.04 to 0.72; p= 0.029). Hypertension directly decreased with high physical activity (b= -0.04; 95%CI= -0.07 to -0.004; p= 0.027), vegetable and fruit consumption (b= -1.13; 95%CI= -2.07 to -0.19; p= 0.037). Hypertension was indirectly affected by anxiety, physical activity, quality of sleep, and coffe drink consumption through BMI and quality of sleep.

Conclusion: Hypertension is directly and positively affected by anxiety, stress, poor quality of sleep, BMI, coffee drink consumption, and soft drink consumption, but negatively affected by high physical activity, vegetable and fruit consumption.

Keywords: hypertension, biopsychosocial, determinants

Correspondence: Febry Istyanto. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta, Central Java 57126. Email: 082133452012

Journal of Epidemiology and Public Health (2019), 4(2): 70-80

Full Text:



Dinas Kesehatan Provinsi Jawa Tengah (2016). Profil Kesehatan Provinsi Jawa Tengah. Dinas Kesehatan Provinsi Jawa Tengah.

Dinda A, Pradani A, Mudigdo A, Qadrijati I (2018). Predictors of hypertension in postmenopausal women in Surakarta, Central Java. 3: 312–322.

Fuchs D (2018). Essentials of hypertension. Springer International Publishing. Switzerland

Gallagher ML (2008). The nutrient and their metabolism. Krause’s food and Nutrition Therapy. 5-22

Garfinkle MA (2017). Salt and essential hypertension: pathophysiology and implications for treatment. Journal of the American Society of Hypertension.

Grosso G (2017). Longterm coffee consumption is associated with decreased incidence of newonset hypertension: a dose-response meta-analysis. Nutrients. 9(8): 890. doi: 10.3390/nu9080890.

Hamrah MS, Hamrah MH, Ishii H, Suzuki S, Hamrah MH, Hamrah AE, Murohara T (2018). Anxiety and Depression among Hypertensive Outpatients in Afghanistan: A Cross-Sectional Study in Andkhoy City. International Journal of Hypertension.

Haryani N, Subiyanto AA, Suryani N (2016). Effect of Health Education on Health Behavior in Patients with Hypertension, 1(1): 9–18.

Houston M (2009). Handbook of Hypertension. First Edition. WilleyBlackwell

Hu F (2013). Resolved: there is sufficient scientific evidence that decreasing sugar sweetened beverage consumption will reduce the prevalence of obesity and obesityrelated diseases. Obes Rev. 14(8): 60619. doi: 10.1111/obr.12040.

James WPT, Mars T (2015). Obesity. Oxford Textbook of Global Public Health sixth edition. Oxford University Press. 970-991.

Jhonson RJ, Perez SE, Sautin YY, Manitius J, Sanchez LG, Feig DI (2009). Could Excessive Fructose Intake and Uric Acid Type 2 Diabetes?. Endocr Rev. 30(1): 96116. doi: 10.1210/er.20080033.

Khalil S, Almobarak AO, Awadalla H, Elmadhoun WM, Noor SK, Sulaiman AA, Ahmed MH (2017). Low levels of physical activity in Sudanese individuals with some features of metabolic syndrome: Population based study. Diabetes Metab Syndr. 11(2): S551S554. doi: 10.1016/j.dsx.2017.04.003.

Keim N, Levin R, Havel P (2006). Major Dietery Constituent and Energy Needs. Modern Nutrition in Health and Disease, 6-74.

Kementerian Kesehatan Republik Indonesia (2017). Profil penyakit tidak menular. dirjen pengendalian penyakit tidak menular Kementerian Kesehatan RI.

_____ (2018). Hasil utama riset kesehatan dasar. Kementerian Kesehatan RI.

Kim J, Kim J (2017). Association between fruit and vegetable consumption and risk of hypertension in middleaged and older korean adults. Journal of the Academy of Nutrition and Dietetics. J Acad Nutr Diet. 118(8):14381449.e5. doi: 10.1016/j.jand.2017.08.122.

Liu M, Li N, Li WA, Khan H (2017). Association between psychosocial stress and hypertension: a systematic review and metaanalysis. Neurol Res. 39(6): 573580. doi: 10.1080/01616412.2017.1317904.

Lo K, Woo B, Wong M, Tam W (2018). Subjective sleep quality, blood pressure, and hypertension: a meta analysis. J Clin Hypertens (Greenwich). 20(3): 592-605. doi: 10.1111/jch.13220.

Malik A, Akram Y, Shetty S, Malik S, Yanchou NV (2014). Impact of sugar sweetened beverages on blood pressure. Am J Cardiol, 1574– 1580.

Mind Garden (1994). Perceived Stress Scale by Sheldon Cohen hosted by

Murti B (2017). Prinsip dan Metode Riset Epidemiologi. Edisi II.Cetakan I. Program Studi Ilmu Kesehatan Masyarakat, Program Pascasarjana, Universitas Sebelas Maret. Surakarta.

Peltzer K, Pengpid S (2018). The prevalence and social determinants of hypertension among adults in Indonesia: A cross sectional populationbased national survey. International Journal of Hypertension.

Puspita RC, Tamtomo D, Indarto D (2017). Health Belief Model for the Analysis of Factors Affecting Hypertension Preventive Behavior among Adolescents in Surakarta, 1172: 183–196.

Puspitosari A, Soemanto RB, Wijaya M (2016). Factors associated with exercise among elderly in Boyolali, Indonesia. Journal of Health Promotion and Behavior, 1(1): 41-45.

Ramadhani ET, Sulistyorini Y (2018). Relationship between Obesity with Hypertension in East Java. Jurnal Berkala Epidemiologi, 6(1): 47-56. doi: 10.20473/jbe.v6i1.2018. 47-56.

Setiyaningsih R, Tamtomo D, Suryani N (2016). Health belief model: determinants of hypertension prevention behavior in adults at community health center, Sukoharjo, Central Java. Journal of Health Promotion and Behavior. 1(3): 161-171.

Souza B, Cunha D, Pereira R, Sichieri R (2016). Soft drink consumption, mainly diet ones, is associated with increased blood pressure in adolescents. J Hypertens. 34(2): 221-5. doi: 10.1097/HJH.0000000000000800.

Wong ND (2015). Epidemiology and prevention of cardiovascular disease. hlm. 909-922. in Oxford Textbook of Global Public Health sixth edition. Oxford University Press.

World Health Organization (2017).Non communicable diseases. Geneva: WHO. Tersedia

Yusrizal M, Indarto D, Akhyar M (2016). Risk of Hypertension in Overweight Adolescents in Pangkalpinang, Indonesia. Journal of Epidemiology and Public Health. 1(1): 27-36.


  • There are currently no refbacks.