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Vo
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13
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lo
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u
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B
o
d
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ass
in
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ex
C
en
tr
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b
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p
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cir
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T
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s
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c
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CC B
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C
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p
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A
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r
:
W
ah
y
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T
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d
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to
Dep
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Ph
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th
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p
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Fa
cu
lty
o
f
Hea
lth
Scien
ce
s
,
Un
iv
er
s
itas
Mu
h
am
m
ad
iy
ah
Su
r
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k
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ta
Su
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ar
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C
en
tr
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J
av
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I
n
d
o
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E
m
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wts
8
3
1
@
u
m
s
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Hy
p
er
ten
s
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a
s
ig
n
if
ica
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t
g
lo
b
al
lo
n
g
-
ter
m
h
ea
lth
p
r
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b
lem
th
at
s
p
an
s
all
life
s
tag
es.
Du
e
to
th
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cu
m
u
lativ
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im
p
ac
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o
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m
aj
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ity
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p
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tio
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H
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lo
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m
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ca
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b
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ain
,
h
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a
n
d
k
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[
1
]
.
T
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b
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n
o
f
h
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p
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1
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5
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5
[
2
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I
n
2
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1
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d
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in
ev
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f
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wo
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[
3
]
.
T
h
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im
p
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tan
c
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as
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m
in
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[
4
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Ho
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s
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W
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[
5
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,
in
I
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r
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is
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p
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cr
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Ob
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ca
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k
f
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to
r
[
6
]
.
I
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[
7
]
.
C
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[
8
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an
d
Han
an
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L
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[
9
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r
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at
h
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6
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C
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wai
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is
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f
av
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tech
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f
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r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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I
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b
lic
Hea
lth
Sci
,
Vo
l.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
5
9
9
-
1
6
0
8
1600
m
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W
C
)
an
d
th
e
in
cid
en
ce
o
f
elev
ated
b
lo
o
d
p
r
ess
u
r
e
am
o
n
g
ad
u
lts
an
d
o
ld
er
p
eo
p
le
[
1
6
]
–
[
1
8
]
,
b
u
t
f
ew
h
av
e
an
aly
ze
d
th
e
r
elatio
n
s
h
ip
b
etwe
en
W
C
v
ar
iatio
n
an
d
c
h
an
g
es
in
b
lo
o
d
p
r
ess
u
r
e.
Prio
r
in
v
esti
g
atio
n
in
C
h
in
a
h
as
h
ig
h
lig
h
ted
th
e
im
p
ac
t
o
f
s
o
c
io
ec
o
n
o
m
ic
an
d
life
s
ty
le
f
ac
t
o
r
s
o
n
h
y
p
er
ten
s
io
n
am
o
n
g
t
h
e
eld
er
ly
th
r
o
u
g
h
s
tr
u
ctu
r
al
eq
u
ati
o
n
m
o
d
els
(
S
E
M)
.
Alth
o
u
g
h
p
r
e
v
io
u
s
s
tu
d
i
es
in
co
r
p
o
r
ated
B
MI
an
d
waist
cir
cu
m
f
er
en
ce
as
v
ar
iab
les,
th
ese
m
ea
s
u
r
em
en
t
s
wer
e
p
r
im
ar
ily
tr
ea
ted
as
o
u
tco
m
es,
leav
in
g
t
h
e
u
n
d
er
ly
i
n
g
m
ec
h
a
n
is
m
s
o
f
h
o
w
B
MI
an
d
W
C
co
n
tr
ib
u
te
to
h
ig
h
b
lo
o
d
p
r
ess
u
r
e
in
th
e
e
ld
er
ly
u
n
ex
p
lo
r
ed
[
1
9
]
,
[
2
0
]
.
T
h
e
p
r
esen
t
s
tu
d
y
is
ex
p
ec
ted
to
p
r
o
v
id
e
ev
i
d
en
ce
o
f
th
e
s
ig
n
i
f
ican
ce
o
f
m
ain
tain
in
g
a
h
ea
lth
y
b
o
d
y
m
ass
in
d
ex
,
waist
cir
cu
m
f
er
en
ce
,
an
d
b
lo
o
d
p
r
e
s
s
u
r
e
lev
els
o
n
a
r
eg
u
lar
m
ea
s
u
r
em
en
t
in
o
ld
er
p
eo
p
le
wh
o
v
is
it
an
in
teg
r
ated
h
ea
lth
p
o
s
ts
[
2
1
]
.
T
h
is
s
tu
d
y
a
im
ed
to
in
v
esti
g
ate
d
ir
ec
t
a
n
d
in
d
ir
ec
t
r
is
k
f
ac
to
r
s
(
ag
e,
g
e
n
d
er
,
B
MI
,
a
n
d
W
C
)
o
f
b
lo
o
d
p
r
ess
u
r
e
in
th
e
eld
e
r
l
y
an
d
e
x
p
lo
r
e
its
u
n
d
er
ly
i
n
g
m
ec
h
an
is
m
s
u
s
in
g
a
SEM
.
2.
M
E
T
H
O
D
3
.
1
.
Study
des
ig
n
a
nd
pa
rt
icipa
nts
T
h
is
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
wa
s
ca
r
r
ied
o
u
t
in
Su
r
ak
ar
ta,
C
en
tr
al
J
av
a,
I
n
d
o
n
esia,
f
r
o
m
Octo
b
er
to
No
v
em
b
er
2
0
2
2
.
T
h
is
s
tu
d
y
u
s
ed
th
e
r
u
le
o
f
th
u
m
b
o
f
1
0
0
o
r
2
0
0
-
s
am
p
le
m
in
im
u
m
th
at
h
as
p
r
ev
io
u
s
ly
b
ee
n
s
u
g
g
ested
f
o
r
SEM
s
[
2
2
]
,
[
2
3
]
.
A
s
am
p
le
o
f
2
9
7
eld
e
r
ly
ag
ed
≥
6
0
y
ea
r
s
o
ld
wh
o
ar
e
atten
d
in
g
i
n
teg
r
ated
h
ea
lth
p
o
s
ts
(
p
o
s
ya
n
d
u
)
f
o
r
eld
er
p
eo
p
le
wer
e
r
ec
r
u
ited
co
n
s
ec
u
tiv
ely
.
Su
b
jects
wh
o
h
ad
a
s
ev
er
e
co
g
n
itiv
e
im
p
air
m
en
t,
s
u
ch
as d
em
en
tia
o
r
s
tr
o
k
e,
wer
e
ex
clu
d
ed
f
r
o
m
th
e
s
tu
d
y
.
3
.
3
.
Study
v
a
ria
bles
T
h
e
d
e
p
en
d
e
n
t
v
ar
iab
les
wer
e
s
y
s
to
lic
an
d
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e.
T
h
e
in
d
ep
en
d
en
t
v
ar
iab
les
in
clu
d
ed
ag
e,
g
e
n
d
er
,
B
MI
,
an
d
waist
cir
cu
m
f
er
en
ce
.
T
h
e
p
ar
ticip
an
ts
'
b
o
d
y
weig
h
t
an
d
h
eig
h
t
wer
e
m
ea
s
u
r
ed
to
d
eter
m
in
e
th
eir
lev
el
o
f
o
b
esit
y
in
ter
m
s
o
f
B
MI
.
Ph
y
s
ical
m
ea
s
u
r
em
e
n
ts
in
clu
d
ed
weig
h
t
(
m
ea
s
u
r
ed
u
s
in
g
d
i
g
ital
s
ca
les),
b
o
d
y
h
ei
g
h
t,
a
n
d
waist
cir
cu
m
f
er
en
ce
.
B
o
d
y
weig
h
t
is
s
tated
in
k
ilo
g
r
a
m
s
(
k
g
)
,
h
eig
h
t
e
x
p
r
ess
ed
in
ce
n
ti
m
eter
s
(
cm
)
,
an
d
waist
cir
cu
m
f
er
en
ce
i
n
ce
n
tim
eter
s
(
cm
)
.
B
MI
was
ca
lcu
lated
as
b
o
d
y
weig
h
t
(
k
g
)
/h
eig
h
t(
m
2
)
.
T
h
e
waist
cir
cu
m
f
er
en
ce
was
m
ea
s
u
r
ed
at
th
e
m
id
p
o
in
t
b
etwe
en
t
h
e
lo
wer
ed
g
e
o
f
th
e
last
r
ib
a
n
d
th
e
ap
ex
o
f
th
e
iliu
m
in
a
h
o
r
izo
n
tal
p
lan
e
with
u
n
its
o
f
0
.
1
cm
.
A
d
ig
ital
s
p
h
y
g
m
o
m
an
o
m
ete
r
was
u
s
ed
to
tak
e
th
e
s
u
b
ject'
s
b
lo
o
d
p
r
ess
u
r
e
twice
wh
ile
th
ey
wer
e
s
ea
ted
,
with
a
5
-
m
in
u
te
g
ap
b
etwe
en
r
ea
d
in
g
s
.
T
h
e
r
esu
lts
wer
e
r
ep
o
r
ted
as
th
e
m
ea
n
o
f
t
h
e
two
m
ea
s
u
r
es
.
T
h
e
s
tan
d
ar
d
ize
d
m
ea
s
u
r
em
en
t
o
f
b
lo
o
d
p
r
ess
u
r
e,
waist
cir
cu
m
f
e
r
en
ce
,
an
d
b
o
d
y
m
ass
in
d
ex
ad
h
er
es
to
th
e
W
HO
g
u
id
elin
es
(
W
HO)
[
2
4
]
,
[
2
5
]
.
3.
4
.
Sta
t
is
t
ica
l
a
na
ly
s
is
T
o
d
escr
ib
e
t
h
e
ch
a
r
ac
ter
is
tics
o
f
th
e
s
tu
d
y
r
esp
o
n
d
en
t
s
,
ca
teg
o
r
ical
d
ata
was
p
r
e
s
en
ted
as
p
er
ce
n
tag
es
(
%)
an
d
f
r
eq
u
e
n
c
y
(
n
)
,
wh
ile
co
n
tin
u
o
u
s
v
ar
ia
b
les
wer
e
g
iv
e
n
as
m
ea
n
,
s
tan
d
ar
d
d
ev
iatio
n
(
SD)
,
m
in
im
u
m
,
an
d
m
ax
im
u
m
.
T
h
e
in
d
ep
e
n
d
en
t
t
-
test
was
u
s
e
d
to
co
m
p
a
r
e
th
e
ag
e,
waist
cir
cu
m
f
er
en
ce
,
a
n
d
B
MI
o
f
th
e
m
ale
an
d
f
e
m
ale
g
r
o
u
p
s
f
o
r
co
n
tin
u
o
u
s
v
ar
iab
l
es.
W
e
u
s
ed
SEM
with
p
ath
a
n
aly
s
is
to
ass
ess
th
e
r
elatio
n
s
h
ip
b
etwe
en
in
d
ep
en
d
en
t
v
ar
iab
les
an
d
p
o
te
n
tial
m
ed
iato
r
s
(
p
ath
)
ad
ju
s
ted
f
o
r
co
v
ar
iates
[
1
2
]
.
T
h
is
m
u
ltiv
ar
iab
le
an
aly
s
is
is
ca
p
a
b
le
to
m
itig
ate
th
e
ef
f
ec
ts
o
f
co
n
f
o
u
n
d
er
s
[
2
6
]
b
y
a
d
ju
s
tin
g
f
o
r
ag
e
an
d
g
en
d
er
.
Dir
ec
t
ef
f
ec
ts
ar
e
s
h
o
wn
b
y
an
ar
r
o
w
o
r
ig
in
atin
g
f
r
o
m
a
n
ex
o
g
en
o
u
s
v
ar
iab
le
(
ex
p
o
s
u
r
e)
lead
in
g
a
n
d
p
o
in
tin
g
to
an
en
d
o
g
e
n
o
u
s
v
ar
iab
le
(
o
u
tco
m
e)
.
An
in
d
ir
ec
t
ef
f
ec
t
is
n
o
t
o
n
ly
p
o
r
t
r
ay
ed
as
a
m
ed
iatin
g
v
ar
iab
le
with
an
ar
r
o
w
p
o
i
n
tin
g
to
it f
r
o
m
an
e
x
o
g
en
o
u
s
,
b
u
t a
ls
o
p
o
in
ts
to
a
n
o
th
er
e
n
d
o
g
en
o
u
s
[
1
2
]
.
A
n
o
n
-
in
s
ig
n
i
f
ican
t
ch
i
2
v
al
u
e
(
p
>0
.
0
5
)
i
n
d
icate
s
a
g
o
o
d
m
o
d
el
f
it
.
T
h
e
p
r
e
f
er
r
ed
v
al
u
e
o
f
th
e
g
o
o
d
n
ess
o
f
f
it
(
G
o
F
)
in
d
ices
o
f
m
o
d
els
in
SEM
,
i
n
clu
d
in
g
n
o
r
m
ed
f
it
in
d
ex
(
NFI
)
,
c
o
m
p
ar
ativ
e
f
it
i
n
d
ex
(
C
FI)
,
T
u
ck
er
-
L
ewis
in
d
ex
(
T
L
I
)
,
is
0
.
9
0
o
r
h
ig
h
er
[
2
7
]
,
[
2
8
]
.
A
g
o
o
d
f
it
ca
n
b
e
d
eter
m
in
e
d
with
an
R
MSE
A
v
alu
e
o
f
<0
.
0
5
,
w
h
ile
a
s
co
r
e
o
f
u
p
to
0
.
0
8
is
co
n
s
id
er
ed
ac
ce
p
tab
le
[
2
9
]
–
[
3
1
]
.
T
h
e
“
Ak
aik
e
in
f
o
r
m
atio
n
cr
iter
io
n
”
(
AI
C
)
a
n
d
“Bay
esian
(
o
r
Sch
war
z)
i
n
f
o
r
m
atio
n
cr
iter
io
n
”
(
B
I
C
)
ar
e
a
p
p
licab
l
e
to
ass
ess
te
f
it
o
f
d
if
f
er
en
ce
m
o
d
els
r
ath
er
t
h
an
to
ju
d
g
e
it
in
ab
s
o
lu
te
ter
m
s
.
Sm
aller
v
alu
es
s
u
g
g
est
a
b
etter
f
it
[
3
2
]
.
T
h
e
r
esu
lts
ar
e
p
r
esen
ted
as
p
ath
co
ef
f
icien
t
(
b
)
an
d
9
5
%
co
n
f
id
en
ce
in
ter
v
al
(
C
I
s
)
.
All
r
ep
o
r
ted
two
-
s
id
ed
p
-
v
alu
es <
0
.
0
5
0
we
r
e
in
ter
p
r
e
ted
as st
atis
t
ically
s
ig
n
if
ican
t.
All a
n
aly
s
es r
u
n
o
n
Stata
1
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
S
tr
u
ctu
r
a
l e
q
u
a
tio
n
mo
d
elin
g
:
ex
p
lo
r
in
g
r
ela
tio
n
s
h
ip
s
o
f
b
o
d
y
ma
s
s
…
(
Wa
h
yu
Tr
i S
u
d
a
r
ya
n
to
)
1601
3.
5
.
E
t
hica
l C
o
ns
i
dera
t
io
ns
All
s
tu
d
y
p
ar
ticip
an
ts
g
a
v
e
th
e
ir
wr
itten
co
n
s
en
t
a
f
ter
h
a
v
in
g
b
ee
n
in
f
o
r
m
e
d
in
d
etail
ab
o
u
t
th
e
s
tu
d
y
o
b
jectiv
es
an
d
p
r
o
ce
d
u
r
es
o
f
t
h
e
s
tu
d
y
p
r
i
o
r
to
p
a
r
ticip
atio
n
.
An
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
em
e
n
ts
wer
e
p
er
f
o
r
m
ed
as
p
ar
t
o
f
a
g
en
e
r
al
h
ea
lth
ex
a
m
in
atio
n
,
a
n
d
p
ar
ticip
an
ts
wer
e
in
f
o
r
m
ed
o
f
th
e
r
esu
lts
.
B
ef
o
r
e
en
r
o
llm
en
t,
th
is
s
tu
d
y
was
r
ev
iewe
d
a
n
d
ap
p
r
o
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b
y
th
e
R
esear
ch
E
th
ics
C
o
m
m
ittee
o
f
t
h
e
Facu
lty
o
f
M
ed
icin
e,
Un
iv
er
s
itas
Mu
h
am
m
ad
iy
a
h
Su
r
a
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n
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4
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/B
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RE
SU
L
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D
D
I
SCU
SS
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h
e
s
am
p
le
ch
ar
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ter
is
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o
f
s
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d
y
s
u
b
jects
ar
e
s
u
m
m
ar
ized
in
T
ab
le
1
.
T
wo
h
u
n
d
r
ed
an
d
n
in
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-
s
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en
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er
ly
wer
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s
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o
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em
,
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s
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g
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.
T
ab
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1
.
Sam
p
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ar
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V
a
r
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a
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s
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n
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M
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n
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m
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r
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W
a
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e
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S
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c
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l
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d
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r
e
ss
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r
e
(
mm
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g
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1
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3
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D
i
a
st
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c
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d
p
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e
ss
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r
e
(
mm
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g
)
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3
.
1
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SE
M
m
o
del
W
e
cr
ea
ted
two
ty
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es
o
f
p
ath
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aly
s
is
m
o
d
els
f
o
r
o
u
r
r
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ch
an
d
i
n
clu
d
ed
all
v
ar
iab
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i
n
th
e
two
m
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Fig
u
r
e
1
s
tan
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ized
SEM
m
o
d
el
o
f
f
ac
to
r
s
r
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Fig
u
r
e
1
(
a
)
an
d
(
b
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s
h
o
w
th
e
f
in
al
SEM
m
o
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el
o
f
f
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P
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d
DB
P
.
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ab
les
2
an
d
3
s
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Fig
u
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T
h
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r
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b
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13
,
No
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4
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Dec
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b
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20
24
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9
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cir
cu
m
f
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Ho
wev
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th
e
p
ath
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also
s
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t
h
a
t
b
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d
y
m
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d
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n
d
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o
ld
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le
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cu
m
f
er
e
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ce
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T
ab
le
2
r
ep
o
r
ted
th
e
r
esu
lts
o
f
u
n
s
tan
d
ar
d
ize
d
an
d
s
tan
d
ar
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ized
co
ef
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ts
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f
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ath
an
al
y
s
is
m
o
d
el
u
s
in
g
SEM
o
n
f
ac
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s
r
elate
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b
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p
r
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r
e
in
eld
er
ly
.
T
a
b
le
2
s
h
o
we
d
t
h
at
s
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e
was
d
ir
ec
tly
af
f
ec
t
ed
b
y
ag
e,
g
e
n
d
er
,
an
d
wai
s
t
cir
cu
m
f
er
en
ce
.
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s
to
lic
b
lo
o
d
p
r
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r
e
was
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d
ir
ec
tly
af
f
ec
ted
b
y
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d
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o
d
y
m
ass
in
d
ex
th
r
o
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g
h
wa
is
t
cir
cu
m
f
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ce
.
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le
h
ad
lo
wer
s
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e
th
an
f
em
ale,
b
u
t
it
was
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t
ically
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o
n
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s
ig
n
if
ican
t
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0
1
;9
5
%
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I
=
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0
.
1
2
to
0
.
1
0
;
p
=
0
.
8
7
2
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.
Ag
e
(
β=0
.
1
4
;
9
5
%
CI
=0
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0
3
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0
.
2
5
;
p
=0
.
0
1
1
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a
n
d
waist
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cu
m
f
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en
ce
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tly
in
c
r
ea
s
ed
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y
s
to
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d
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ess
u
r
e
(
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.
2
1
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% C
I
=0
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1
1
t
o
0
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3
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<0
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0
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.
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ab
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2
.
Stru
ctu
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eq
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d
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f
f
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elate
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r
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1
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0
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1
7
0
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0
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1
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M
I
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k
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B
W
/
m
2
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8
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1
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5
2
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2
3
<
0
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0
0
1
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5
3
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4
6
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g
e
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2
9
0
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0
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1
0
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0
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8
0
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1
3
0
.
0
4
0
.
2
2
0
.
0
0
7
In
d
i
r
e
c
t
e
f
f
e
c
t
S
B
P
A
g
e
0
.
1
0
0
.
0
1
0
.
1
9
0
.
0
2
9
B
M
I
0
.
6
6
0
.
3
0
1
.
0
2
<
0
.
0
0
1
T
o
t
a
l
e
f
f
e
c
t
S
B
P
W
C
A
g
e
0
.
6
2
0
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2
1
1
.
0
3
0
.
0
0
3
S
B
P
W
C
B
M
I
0
.
6
6
0
.
3
0
1
.
0
2
<
0
.
0
0
1
T
ab
le
3
r
ep
o
r
ted
th
e
r
esu
lts
o
f
u
n
s
tan
d
ar
d
ize
d
an
d
s
tan
d
ar
d
ized
co
ef
f
icien
ts
o
f
p
ath
an
al
y
s
is
m
o
d
el
u
s
in
g
SEM
o
n
f
ac
to
r
s
r
elate
d
to
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
in
eld
er
ly
.
T
a
b
le
3
s
h
o
wed
th
at
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
was
d
ir
ec
tly
af
f
ec
te
d
b
y
ag
e
,
g
e
n
d
er
,
b
o
d
y
m
ass
in
d
ex
,
an
d
waist
cir
cu
m
f
er
e
n
ce
.
Diasto
lic
b
lo
o
d
p
r
ess
u
r
e
was
in
d
ir
ec
tly
af
f
ec
t
ed
b
y
ag
e
a
n
d
b
o
d
y
m
ass
in
d
ex
th
r
o
u
g
h
waist
cir
cu
m
f
er
e
n
c
e.
Ma
les
h
ad
h
ig
h
er
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
(
D
B
P
)
th
an
f
em
ales,
alth
o
u
g
h
th
e
d
if
f
e
r
en
ce
was
n
o
t
s
tatis
tically
s
ig
n
if
ican
t
(
β=0
.
0
7
;9
5
%
C
I
=
-
0
.
0
4
t
o
0
.
1
8
;
p
=0
.
2
3
0
)
.
Ag
e
d
ir
ec
tly
lo
wer
ed
o
f
d
iast
o
lic
b
lo
o
d
p
r
e
s
s
u
r
e
b
y
0
.
0
2
u
n
its
(
β=
-
0
.
0
2
;
9
5
%
CI
=
-
0
.
1
3
to
0
.
1
0
;
p
=0
.
7
9
0
)
.
W
aist
cir
cu
m
f
e
r
en
ce
d
ir
ec
tly
r
aised
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
b
y
0
.
0
4
u
n
its
,
b
u
t
th
e
e
f
f
ec
t
was
s
tatis
tically
n
o
n
-
s
ig
n
if
ican
t
(
β=0
.
0
4
;
9
5
%
C
I
=
-
0
.
0
9
to
0
.
1
7
;
p
=0
.
5
7
0
)
.
B
o
d
y
m
ass
in
d
ex
d
ir
ec
tly
an
d
s
ig
n
if
ican
tly
in
cr
ea
s
ed
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
b
y
0
.
1
2
u
n
its
(
β=0
.
4
0
;
9
5
%
C
I
=
-
0
.
0
1
to
0
.
2
6
;
p
=0
.
0
6
4
)
.
3
.
2
.
G
o
o
dn
ess
o
f
f
it
ind
ices f
o
r
SE
M
m
o
dels
T
ab
le
4
d
escr
ib
es
th
e
g
o
o
d
n
e
s
s
-
of
-
f
it
s
tatis
t
ics
o
f
th
e
m
o
d
el
.
T
h
e
f
in
al
m
o
d
el
in
t
h
is
s
t
u
d
y
h
a
d
a
g
o
o
d
f
it
.
T
h
e
k
e
y
f
in
d
i
n
g
o
f
r
ec
en
t
s
tu
d
y
was
th
at
wai
s
t
cir
cu
m
f
er
en
ce
was
d
ir
ec
tly
ass
o
ciate
d
with
s
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e.
Me
an
wh
ile,
B
MI
h
ad
d
ir
ec
t
co
r
r
elatio
n
with
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
.
Pre
v
io
u
s
f
in
d
in
g
s
s
h
o
wed
a
c
o
n
s
is
ten
t
an
d
s
tr
o
n
g
ass
o
ciatio
n
b
etwe
en
W
C
g
ain
an
d
b
l
o
o
d
p
r
ess
u
r
e
in
cr
ea
s
e
[
1
1
]
,
[
2
0
]
Ho
wev
er
,
th
o
s
e
s
tu
d
y
d
id
n
o
t
ex
p
lain
wh
eth
er
th
is
ass
o
ciat
io
n
in
d
u
ce
d
s
y
s
to
lic
o
r
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
alo
n
e,
o
r
b
o
th
s
im
u
ltan
eo
u
s
ly
.
Nev
er
th
eless
,
s
ev
er
al
s
tu
d
ies
h
av
e
p
r
o
v
id
ed
an
e
x
p
lan
atio
n
o
f
th
e
m
ec
h
an
is
m
o
f
waist
cir
cu
m
f
er
en
ce
a
n
d
its
ef
f
ec
t
o
n
b
lo
o
d
p
r
ess
u
r
e
in
cr
ea
s
es.
A
s
tu
d
y
b
y
T
r
an
et
a
l.
[
1
1
]
f
o
u
n
d
th
at
W
C
in
d
ep
en
d
en
tly
ass
o
ciate
d
with
b
lo
o
d
p
r
ess
u
r
e.
B
am
aiy
i
et
a
l.
s
tu
d
y
[
3
3
]
s
im
ilar
ly
in
d
icat
ed
n
o
n
-
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
in
th
e
in
d
ep
en
d
en
t
in
ter
ac
tio
n
s
b
etwe
en
waist
cir
cu
m
f
er
en
ce
an
d
b
lo
o
d
p
r
ess
u
r
e,
as
d
em
o
n
s
tr
ated
b
y
a
m
u
ltip
le
lo
g
is
tic
r
eg
r
ess
io
n
test
.
I
n
co
m
p
a
r
is
o
n
to
o
t
h
er
r
esear
ch
,
o
u
r
s
tu
d
y
u
n
iq
u
ely
co
n
tr
ib
u
tes
b
y
p
r
o
v
id
i
n
g
a
d
etailed
u
n
d
e
r
s
tan
d
in
g
o
f
th
e
m
ec
h
an
is
m
s
u
n
d
er
ly
in
g
th
e
ef
f
ec
ts
o
f
B
MI
an
d
W
C
o
n
b
o
th
s
y
s
to
lic
an
d
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
in
th
e
eld
er
ly
.
C
o
m
p
ar
ed
to
o
th
er
s
tu
d
ies,
o
u
r
r
esear
ch
m
ak
es
a
d
is
tin
ctiv
e
co
n
tr
ib
u
tio
n
b
y
o
f
f
er
in
g
a
n
u
an
ce
d
u
n
d
e
r
s
tan
d
in
g
o
f
th
e
m
ec
h
an
is
m
s
th
at
u
n
d
er
s
co
r
e
th
e
im
p
ac
t o
f
B
MI
an
d
waist cir
cu
m
f
er
en
ce
o
n
b
o
t
h
s
y
s
to
lic
an
d
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
in
th
e
eld
er
ly
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
S
tr
u
ctu
r
a
l e
q
u
a
tio
n
mo
d
elin
g
:
ex
p
lo
r
in
g
r
ela
tio
n
s
h
ip
s
o
f
b
o
d
y
ma
s
s
…
(
Wa
h
yu
Tr
i S
u
d
a
r
ya
n
to
)
1603
T
ab
le
3
.
Stru
ctu
r
al
eq
u
atio
n
m
o
d
el
o
f
f
ac
to
r
s
r
elate
d
to
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
in
el
d
er
ly
(
n
=
2
9
7
)
D
e
p
e
n
d
e
n
t
v
a
r
i
a
b
l
e
I
n
d
e
p
e
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e
n
t
v
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r
i
a
b
l
e
U
n
st
a
n
d
a
r
d
i
z
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d
p
a
t
h
c
o
e
f
.
(
b
)
9
5
%
C
I
p
S
t
a
n
d
a
r
d
i
z
e
d
p
a
t
h
c
o
e
f
.
(
β)
9
5
%
C
I
p
Lo
w
e
r
l
i
m
i
t
U
p
p
e
r
l
i
m
i
t
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w
e
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l
i
m
i
t
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p
p
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l
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m
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t
D
i
r
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t
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f
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t
D
B
P
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r
(
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1
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2
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1
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W
C
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c
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0
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5
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1
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4
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2
2
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0
7
In
d
i
r
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c
t
e
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f
e
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t
D
B
P
B
M
I
0
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6
0
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0
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7
1
A
g
e
0
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0
1
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0
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0
3
0
.
0
5
0
.
5
7
9
T
o
t
a
l
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f
f
e
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t
D
B
P
B
M
I
0
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4
7
0
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1
0
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3
0
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2
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g
e
-
0
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0
2
-
0
.
2
5
0
.
2
1
0
.
8
5
5
T
ab
le
4
.
T
h
e
r
esu
lts
o
f
g
o
o
d
n
e
s
s
-
of
-
f
it st
atis
tic
s
f
o
r
SEM
o
f
f
ac
to
r
s
r
elate
d
to
s
y
s
to
lic
an
d
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
in
eld
er
ly
G
o
o
d
n
e
ss
o
f
f
i
t
S
EM
m
o
d
e
l
o
f
f
a
c
t
o
r
s
r
e
l
a
t
e
d
t
o
sy
st
o
l
i
c
b
l
o
o
d
p
r
e
ss
u
r
e
S
EM
m
o
d
e
l
o
f
f
a
c
t
o
r
s
r
e
l
a
t
e
d
t
o
d
i
a
st
o
l
i
c
b
l
o
o
d
p
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ss
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e
A
c
c
e
p
t
e
d
r
a
n
g
e
C
h
i
2
0
.
2
0
0
.
1
8
N
/
A
P
0
.
9
0
6
0
.
6
6
9
>
0
.
0
5
0
R
o
o
t
M
e
a
n
S
q
u
a
r
e
A
p
p
r
o
x
i
m
a
t
i
o
n
(
R
M
S
EA
)
<
0
.
0
0
1
<
0
.
0
0
1
<
0
.
0
8
0
A
k
a
i
k
e
'
s i
n
f
o
r
m
a
t
i
o
n
c
r
i
t
e
r
i
o
n
(
A
I
C
)
9
,
0
4
0
.
7
7
8
,
7
0
8
.
9
2
3
N
/
A
B
a
y
e
s
i
a
n
i
n
f
o
r
mat
i
o
n
c
r
i
t
e
r
i
o
n
(
B
I
C
)
9
,
0
7
4
.
0
1
8
,
7
4
5
.
8
6
N
/
A
C
o
m
p
a
r
a
t
i
v
e
f
i
t
i
n
d
e
x
(
C
F
I
)
1
.
0
0
1
.
0
0
≥
0
.
9
0
Tu
c
k
e
r
-
L
e
w
i
s
i
n
d
e
x
(
TLI
)
1
.
0
5
1
.
0
6
≥
0
.
9
5
S
t
a
n
d
a
r
d
i
z
e
d
r
o
o
t
m
e
a
n
s
q
u
a
r
e
d
r
e
si
d
u
a
l
(
S
R
M
R
)
0
.
0
0
5
0
.
0
0
5
0
C
o
e
f
f
i
c
i
e
n
t
o
f
d
e
t
e
r
m
i
n
a
t
i
o
n
(
C
D
)
0
.
3
1
0
.
3
0
1
Lo
g
l
i
k
e
l
i
h
o
o
d
-
4
,
5
1
1
.
3
8
-
4
,
3
4
4
.
4
6
N
/
A
Hig
h
lev
els
o
f
waist
cir
cu
m
f
e
r
en
ce
an
d
in
tr
a
-
ab
d
o
m
in
al
a
d
i
p
o
s
e
tis
s
u
e
(
I
AAT
)
in
c
r
ea
s
e
t
h
e
r
is
k
o
f
ca
r
d
io
m
etab
o
lic
illn
ess
[
1
1
]
,
[
3
4
]
.
R
o
s
s
et
a
l.
[
3
5
]
d
ec
lar
ed
th
at
n
u
m
er
o
u
s
s
tu
d
ies
d
em
o
n
s
tr
ate
a
s
ig
n
if
ican
t
ass
o
ciatio
n
b
etwe
en
waist
cir
cu
m
f
er
en
ce
,
m
o
r
b
i
d
ity
,
an
d
r
i
s
k
o
f
d
ea
th
in
ep
id
em
io
lo
g
ica
l
co
h
o
r
ts
.
No
tab
ly
,
in
d
iv
id
u
als
with
n
o
r
m
al
B
MI
(
2
0
.
0
-
2
4
.
9
k
g
/m
2
)
h
ad
a
h
ig
h
er
r
is
k
o
f
all
-
ca
u
s
e
d
ea
th
wh
en
th
eir
waist
cir
cu
m
f
er
en
ce
e
x
ce
ed
ed
t
h
e
cr
iter
ia
[
3
6
]
.
T
h
e
Ath
e
r
o
s
cler
o
s
is
R
i
s
k
in
C
o
m
m
u
n
ities
r
esear
ch
,
wh
ich
f
o
llo
wed
1
4
,
6
9
9
b
lack
p
e
o
p
le
f
o
r
n
in
e
y
ea
r
s
,
in
d
icate
d
th
at
waist
cir
cu
m
f
er
en
ce
in
c
r
ea
s
ed
th
e
r
is
k
o
f
co
r
o
n
ar
y
h
ea
r
t
d
is
ea
s
e
(
R
R
=1
.
3
7
;
9
5
%
C
I
=1
.
2
1
to
1
.
5
6
)
[
3
7
]
.
A
s
tu
d
y
b
y
Su
n
et
a
l.
[
1
0
]
h
ig
h
lig
h
t
ed
th
e
r
elatio
n
s
h
ip
b
etwe
en
waist
cir
cu
m
f
er
en
ce
an
d
(
p
r
e)
h
y
p
e
r
ten
s
io
n
r
is
k
in
a
r
ep
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4
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Dec
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20
24
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d
waist
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[
4
9
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–
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5
1
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.
At
later
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in
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m
all
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[
54
]
.
C
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5
5
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lead
in
g
in
th
e
s
tiff
e
n
in
g
o
f
th
ese
v
ess
els,
lo
s
s
o
f
co
m
p
lian
ce
,
an
d
elastic r
ec
o
il.
T
h
is
SEM
,
em
p
lo
y
in
g
p
ath
a
n
aly
s
is
,
also
r
ep
o
r
ted
th
at
g
e
n
d
er
s
h
o
wed
n
o
s
ig
n
if
ican
t
c
o
r
r
elatio
n
with
SB
P
o
r
DB
P.
T
h
e
r
o
les
o
f
s
ex
an
d
g
e
n
d
er
in
b
lo
o
d
p
r
ess
u
r
e
h
av
e
n
o
t
b
ee
n
s
y
s
tem
atica
lly
clar
if
ied
,
an
d
ea
r
lier
r
esear
ch
h
as
i
n
d
icate
d
th
at
th
ese
m
ec
h
an
is
m
s
ar
e
m
o
r
e
d
if
f
icu
lt
to
g
r
asp
th
an
th
e
p
r
esen
ce
o
r
ab
s
en
ce
o
f
s
ex
h
o
r
m
o
n
es
o
r
th
e
s
ex
ch
r
o
m
o
s
o
m
al
co
m
p
lem
e
n
t.
B
o
th
s
ex
s
ter
o
id
s
an
d
c
h
r
o
m
o
s
o
m
es
m
o
s
t
lik
ely
in
f
lu
en
ce
th
e
m
ec
h
a
n
is
m
s
o
f
b
lo
o
d
p
r
ess
u
r
e
at
v
ar
io
u
s
lev
els
[
5
6
]
,
[
5
7
]
.
Ho
wev
er
,
in
a
lo
n
g
itu
d
in
al
s
tu
d
y
,
it
was
o
b
s
er
v
ed
th
at
f
em
ales
r
e
p
o
r
ted
a
s
ig
n
i
f
ican
tly
s
h
a
r
p
er
in
clin
e
i
n
b
lo
o
d
p
r
ess
u
r
e
s
tar
tin
g
f
r
o
m
th
e
th
ir
d
d
ec
ad
e
o
f
life
.
T
h
is
im
p
lies
u
n
d
er
ly
i
n
g
d
is
tin
ctio
n
s
in
th
e
f
ac
to
r
s
co
n
tr
ib
u
tin
g
to
elev
a
ted
b
lo
o
d
p
r
ess
u
r
e
b
etwe
en
g
en
d
e
r
s
an
d
ad
v
o
ca
te
s
f
o
r
a
co
n
v
er
g
e
n
ce
in
h
y
p
er
te
n
s
io
n
p
r
ev
ale
n
ce
later
in
life
.
T
h
e
s
p
ec
if
ic
ca
u
s
es
o
f
th
ese
d
if
f
er
en
ce
s
,
wh
eth
er
r
o
o
ted
in
b
i
o
lo
g
ical
s
ex
(
s
u
ch
as
s
ex
h
o
r
m
o
n
es,
ch
r
o
m
o
s
o
m
al
co
m
p
lem
en
t,
p
r
eg
n
a
n
cy
,
o
r
e
p
ig
en
etic
c
h
a
n
g
es)
o
r
s
o
cio
cu
ltu
r
al
g
en
d
er
f
ac
to
r
s
(
s
u
c
h
as
p
s
y
c
h
o
s
o
cia
l
tr
aits
lik
e
r
elativ
e
ec
o
n
o
m
ic
d
ep
r
iv
atio
n
)
,
r
e
m
ai
n
u
n
ce
r
tain
[
5
8
]
–
[
6
0
]
4.
CO
NCLU
SI
O
N
I
n
co
n
clu
s
io
n
,
B
MI
an
d
wai
s
t
cir
cu
m
f
er
en
ce
ar
e
s
tr
o
n
g
e
r
p
r
ed
icto
r
f
o
r
elev
ated
b
lo
o
d
p
r
ess
u
r
e.
W
aist
cir
cu
m
f
er
en
ce
is
d
ir
ec
tly
in
cr
ea
s
ed
SB
P.
Me
an
wh
ile,
b
o
d
y
m
ass
in
d
ex
is
d
ir
ec
tly
in
cr
ea
s
ed
DB
P
in
eld
er
ly
.
T
h
is
f
in
d
in
g
h
ig
h
lig
h
t
in
g
th
e
n
ee
d
to
co
m
b
in
e
m
ea
s
u
r
es
in
o
b
esit
y
-
r
elate
d
r
is
k
ass
ess
m
en
t
to
id
en
tif
y
h
y
p
er
ten
s
io
n
in
eld
er
ly
.
T
h
is
s
tu
d
y
p
r
o
v
id
es
im
p
licatio
n
s
th
at
waist
cir
cu
m
f
er
en
ce
m
ea
s
u
r
em
en
ts
ar
e
s
im
p
le,
co
s
t
-
ef
f
ec
tiv
e,
an
d
e
f
f
ec
tiv
e
i
n
id
en
tify
in
g
h
y
p
er
ten
s
io
n
r
is
k
f
ac
to
r
s
in
th
e
eld
er
ly
,
it
is
im
p
er
ativ
e
to
in
clu
d
e
waist
cir
cu
m
f
er
en
ce
ass
es
s
m
e
n
ts
as
p
ar
t
o
f
r
o
u
tin
e
h
ea
lth
ch
ec
k
s
f
o
r
eld
er
ly
in
d
iv
id
u
als,
alo
n
g
s
id
e
tr
ad
itio
n
al
B
MI
m
ea
s
u
r
em
en
ts
.
ACK
NO
WL
E
DG
E
M
E
NT
S
W
e
wo
u
ld
lik
e
to
th
an
k
So
f
iy
an
a
E
lo
k
Sals
ab
ela,
Ar
in
i
Nu
r
Hid
ay
ati,
R
izk
i
Aq
s
y
ar
i
D,
a
n
d
W
u
lan
Ad
is
Ar
an
ti
f
o
r
th
eir
ass
i
s
tan
ce
an
d
s
u
p
er
v
is
io
n
o
f
d
ata
co
ll
ec
tio
n
team
s
.
T
h
is
wo
r
k
was
s
u
p
p
o
r
ted
b
y
g
r
an
t
f
u
n
d
e
d
f
r
o
m
Un
iv
er
s
itas
Mu
h
am
m
ad
i
y
ah
Su
r
a
k
ar
ta,
C
en
tr
al
J
av
a,
I
n
d
o
n
esia
with
Nu
m
b
er
:
9
5
0
.
1
/A.
3
-
I
I
I
/FIK/I
V/2
0
2
2
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
S
tr
u
ctu
r
a
l e
q
u
a
tio
n
mo
d
elin
g
:
ex
p
lo
r
in
g
r
ela
tio
n
s
h
ip
s
o
f
b
o
d
y
ma
s
s
…
(
Wa
h
yu
Tr
i S
u
d
a
r
ya
n
to
)
1605
REFE
RENC
E
S
[
1
]
R
.
N
.
B
.
A
y
o
g
u
,
M
.
G
.
Ez
e
h
,
a
n
d
A
.
M
.
O
k
a
f
o
r
,
“
P
r
e
v
a
l
e
n
c
e
a
n
d
p
r
e
d
i
c
t
o
r
s
o
f
d
i
f
f
e
r
e
n
t
p
a
t
t
e
r
n
s
o
f
h
y
p
e
r
t
e
n
si
o
n
a
mo
n
g
a
d
u
l
t
s
a
g
e
d
2
0
–
6
0
y
e
a
r
s
i
n
r
u
r
a
l
c
o
mm
u
n
i
t
i
e
s
o
f
S
o
u
t
h
e
a
st
N
i
g
e
r
i
a
:
a
c
r
o
ss
-
s
e
c
t
i
o
n
a
l
s
t
u
d
y
,
”
Ar
c
h
i
v
e
s
o
f
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
7
9
,
n
o
.
1
,
p
.
2
1
0
,
D
e
c
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
3
6
9
0
-
0
2
1
-
0
0
7
2
4
-
y.
[
2
]
P
.
M
.
K
e
a
r
n
e
y
,
M
.
W
h
e
l
t
o
n
,
K
.
R
e
y
n
o
l
d
s,
P
.
M
u
n
t
n
e
r
,
P
.
K
.
W
h
e
l
t
o
n
,
a
n
d
J.
H
e
,
“
G
l
o
b
a
l
b
u
r
d
e
n
o
f
h
y
p
e
r
t
e
n
si
o
n
:
a
n
a
l
y
si
s
o
f
w
o
r
l
d
w
i
d
e
d
a
t
a
,
”
T
h
e
L
a
n
c
e
t
,
v
o
l
.
3
6
5
,
n
o
.
9
4
5
5
,
p
p
.
2
1
7
–
2
2
3
,
Ja
n
.
2
0
0
5
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
1
4
0
-
6
7
3
6
(
0
5
)
1
7
7
4
1
-
1.
[
3
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
(
W
H
O
)
,
“
H
y
p
e
r
t
e
n
s
i
o
n
.
”
2
0
2
1
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
n
e
w
s
-
r
o
o
m/
f
a
c
t
-
sh
e
e
t
s
/
d
e
t
a
i
l
/
h
y
p
e
r
t
e
n
si
o
n
[
4
]
N
.
Li
o
n
a
k
i
s
,
“
H
y
p
e
r
t
e
n
s
i
o
n
i
n
t
h
e
e
l
d
e
r
l
y
,
”
W
o
rl
d
J
o
u
r
n
a
l
o
f
C
a
rd
i
o
l
o
g
y
,
v
o
l
.
4
,
n
o
.
5
,
p
.
1
3
5
,
2
0
1
2
,
d
o
i
:
1
0
.
4
3
3
0
/
w
j
c
.
v
4
.
i
5
.
1
3
5
.
[
5
]
V
.
W
i
d
y
a
n
i
n
g
s
i
h
e
t
a
l
.
,
“
M
i
sse
d
o
p
p
o
r
t
u
n
i
t
i
e
s
i
n
h
y
p
e
r
t
e
n
s
i
o
n
r
i
sk
f
a
c
t
o
r
s
s
c
r
e
e
n
i
n
g
i
n
I
n
d
o
n
e
s
i
a
:
a
mi
x
e
d
-
m
e
t
h
o
d
s
e
v
a
l
u
a
t
i
o
n
o
f
i
n
t
e
g
r
a
t
e
d
h
e
a
l
t
h
p
o
st
(
P
O
S
B
I
N
D
U
)
i
mp
l
e
me
n
t
a
t
i
o
n
,
”
BM
J
O
p
e
n
,
v
o
l
.
1
2
,
n
o
.
2
,
p
.
e
0
5
1
3
1
5
,
F
e
b
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
3
6
/
b
mj
o
p
e
n
-
2
0
2
1
-
0
5
1
3
1
5
.
[
6
]
S
.
A
.
K
a
ssi
e
,
K
.
G
.
B
e
y
e
n
e
,
a
n
d
M
.
A
.
Ti
r
u
n
e
h
,
“
D
e
t
e
r
mi
n
a
n
t
s
o
f
h
y
p
e
r
t
e
n
si
o
n
a
m
o
n
g
a
d
u
l
t
s
l
i
v
i
n
g
i
n
B
o
l
e
S
u
b
-
c
i
t
y
,
A
d
d
i
s
A
b
a
b
a
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
Pu
b
l
i
c
H
e
a
l
t
h
S
c
i
e
n
c
e
(
I
J
PH
S
)
,
v
o
l
.
9
,
n
o
.
2
,
p
.
1
2
1
-
1
2
8
,
J
u
n
.
2
0
2
0
,
d
o
i
:
1
0
.
1
1
5
9
1
/
i
j
p
h
s.
v
9
i
2
.
2
0
4
2
7
.
[
7
]
J.
-
P
.
D
e
s
p
r
é
s
a
n
d
I
.
Le
m
i
e
u
x
,
“
A
b
d
o
mi
n
a
l
o
b
e
si
t
y
a
n
d
me
t
a
b
o
l
i
c
s
y
n
d
r
o
m
e
,
”
N
a
t
u
r
e
,
v
o
l
.
4
4
4
,
n
o
.
7
1
2
1
,
p
p
.
8
8
1
–
8
8
7
,
D
e
c
.
2
0
0
6
,
d
o
i
:
1
0
.
1
0
3
8
/
n
a
t
u
r
e
0
5
4
8
8
.
[
8
]
A
.
V
.
C
h
o
b
a
n
i
a
n
,
“
Th
e
S
e
v
e
n
t
h
r
e
p
o
r
t
o
f
t
h
e
j
o
i
n
t
n
a
t
i
o
n
a
l
c
o
mm
i
t
t
e
e
o
n
p
r
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v
e
n
t
i
o
n
,
d
e
t
e
c
t
i
o
n
,
e
v
a
l
u
a
t
i
o
n
,
a
n
d
t
r
e
a
t
m
e
n
t
o
f
h
i
g
h
b
l
o
o
d
p
r
e
ss
u
r
e
T
h
e
JN
C
7
R
e
p
o
r
t
,
”
J
AM
A
,
v
o
l
.
2
8
9
,
n
o
.
1
9
,
p
.
2
5
6
0
,
M
a
y
2
0
0
3
,
d
o
i
:
1
0
.
1
0
0
1
/
j
a
ma.
2
8
9
.
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