{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:15:55Z","timestamp":1758636955262},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>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\u201329.9\u00a0kg\/m<jats:sup>2<\/jats:sup> was classified as obesity I, whereas BMI\u2009\u2265\u200930.0\u00a0kg\/m<jats:sup>2<\/jats:sup> was classified as obesity II. Elevated PP was defined as PP\u2009\u2265\u200950\u00a0mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4\u2009\u00b1\u20093.8\u00a0kg\/m<jats:sup>2<\/jats:sup>, while the average PP was 50.1\u2009\u00b1\u200911.2\u00a0mmHg. Compared to individuals with normal weight, the <jats:inline-formula><jats:alternatives><jats:tex-math>$$\\beta$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                    <mml:mi>\u03b2<\/mml:mi>\n                  <\/mml:math><\/jats:alternatives><\/jats:inline-formula> coefficients of PP and BMI were 1.38 (95% CI: 1.15\u20131.60) and 2.57 (95% CI: 2.25\u20132.88) 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\u201322.9\u00a0kg\/m<jats:sup>2<\/jats:sup>, the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19\u20131.28) and 1.41 (95% CI: 1.35\u20131.48) 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\u20131.08) and 1.09 (95% CI: 1.06\u20131.13) in those with obesity I and obesity II, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12872-023-03390-w","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T15:14:04Z","timestamp":1689693244000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Relationship between pulse pressure and body mass index in active-duty Royal Thai Army personnel in Thailand"],"prefix":"10.1186","volume":"23","author":[{"given":"Boonsub","family":"Sakboonyarat","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaturon","family":"Poovieng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanatip","family":"Sangkool","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sethapong","family":"Lertsakulbunlue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanlaya","family":"Jongcherdchootrakul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phutsapong","family":"Srisawat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathirut","family":"Mungthin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ram","family":"Rangsin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,7,18]]},"reference":[{"key":"3390_CR1","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","volume":"390","author":"M Naghavi","year":"2017","unstructured":"Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980\u20132016: a systematic analysis for the global burden of disease study 2016. The Lancet. 2017;390:1151\u2013210.","journal-title":"The Lancet"},{"key":"3390_CR2","unstructured":"Organization WH. Noncommunicable diseases country profiles 2018. 2018."},{"key":"3390_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12872-018-0887-0","volume":"18","author":"B Sakboonyarat","year":"2018","unstructured":"Sakboonyarat B, Rangsin R. Prevalence and associated factors of ischemic heart disease (IHD) among patients with diabetes mellitus: a nation-wide, cross-sectional survey. BMC Cardiovasc Disord. 2018;18:1\u20137.","journal-title":"BMC Cardiovasc Disord"},{"key":"3390_CR4","doi-asserted-by":"crossref","unstructured":"Fuchs FD, Whelton PK. High Blood Pressure and Cardiovascular Disease. Hypertension. 2020.","DOI":"10.1161\/HYPERTENSIONAHA.119.14240"},{"key":"3390_CR5","doi-asserted-by":"publisher","first-page":"17614","DOI":"10.1038\/s41598-021-96878-4","volume":"11","author":"W Chantkran","year":"2021","unstructured":"Chantkran W, Chaisakul J, Rangsin R, Mungthin M, Sakboonyarat B. Prevalence of and factors associated with stroke in hypertensive patients in Thailand from 2014 to 2018: A nationwide cross-sectional study. Sci Rep. 2021;11:17614.","journal-title":"Sci Rep"},{"key":"3390_CR6","unstructured":"Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. 2021;398."},{"key":"3390_CR7","unstructured":"Aekplakorn W. Thai National Health Examination Survey VI (2019\u20132020). 2019."},{"key":"3390_CR8","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1161\/HYPERTENSIONAHA.119.12684","volume":"73","author":"P Verdecchia","year":"2019","unstructured":"Verdecchia P, Angeli F, Cavallini C, Aita A, Turturiello D, de Fano M, et al. Sudden cardiac death in hypertensive patients. Hypertension. 2019;73:1071\u20138.","journal-title":"Hypertension"},{"key":"3390_CR9","doi-asserted-by":"crossref","unstructured":"Tan NS, Sarak B, Fox KA, Brieger D, Steg PG, Gale CP, et al. Pulse pressure in acute coronary syndromes: comparative prognostic significance with systolic blood pressure. Can J Cardiol. 2016;32.","DOI":"10.1016\/j.cjca.2016.07.318"},{"key":"3390_CR10","doi-asserted-by":"crossref","unstructured":"Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol. 2000;36.","DOI":"10.1016\/S0735-1097(00)00687-2"},{"key":"3390_CR11","first-page":"73","volume-title":"Vasan RS","author":"TJ Niiranen","year":"2019","unstructured":"Niiranen TJ, Kalesan B, Mitchell GF. Vasan RS. The framingham heart study. Hypertension: Relative contributions of pulse pressure and arterial stiffness to cardiovascular disease; 2019. p. 73."},{"key":"3390_CR12","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.010627","volume":"8","author":"M Yamamoto","year":"2019","unstructured":"Yamamoto M, Fujihara K, Ishizawa M, Osawa T, Kaneko M, Ishiguro H, et al. Pulse pressure is a stronger predictor than systolic blood pressure for severe eye diseases in diabetes mellitus. J Am Heart Assoc. 2019;8: e010627.","journal-title":"J Am Heart Assoc"},{"key":"3390_CR13","doi-asserted-by":"publisher","first-page":"e0245801","DOI":"10.1371\/journal.pone.0245801","volume":"16","author":"N Euswas","year":"2021","unstructured":"Euswas N, Phonnopparat N, Morasert K, Thakhampaeng P, Kaewsanit A, Mungthin M, et al. National trends in the prevalence of diabetic retinopathy among Thai patients with type 2 diabetes and its associated factors from 2014 to 2018. PLoS ONE. 2021;16:e0245801\u2013e0245801.","journal-title":"PLoS ONE"},{"key":"3390_CR14","first-page":"14","volume-title":"Chen Y","author":"C Wu","year":"2021","unstructured":"Wu C, Ma D. Chen Y. A cohort study. Int J Gen Med: Association of pulse pressure difference and diabetes mellitus in Chinese people; 2021. p. 14."},{"key":"3390_CR15","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.35755\/jmedassocthai.2021.10.12199","volume":"104","author":"S Kunanon","year":"2021","unstructured":"Kunanon S, Chattranukulchai P, Chotruangnapa C, Kositanurit W, Methavigul K, Boonyasirinant T, et al. 2019 Thai guidelines on the treatment of hypertension: executive summary. J Med Assoc Thai. 2021;104:1729\u201338.","journal-title":"J Med Assoc Thai"},{"key":"3390_CR16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18502\/rmm.v6i1.3919","volume":"6","author":"P Hatthachote","year":"2019","unstructured":"Hatthachote P, Rangsin R, Mungthin M, Sakboonyarat B. Trends in the prevalence of obesity among young Thai men and associated factors: from 2009 to 2016. Mil Med Res. 2019;6:1\u20138.","journal-title":"Mil Med Res"},{"key":"3390_CR17","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1186\/s12889-020-09004-w","volume":"20","author":"B Sakboonyarat","year":"2020","unstructured":"Sakboonyarat B, Pornpongsawad C, Sangkool T, Phanmanas C, Kesonphaet N, Tangthongtawi N, et al. Trends, prevalence and associated factors of obesity among adults in a rural community in Thailand: serial cross-sectional surveys, 2012 and 2018. BMC Public Health. 2020;20:850.","journal-title":"BMC Public Health"},{"key":"3390_CR18","unstructured":"Health Systems Research Institute. Thai National Health Examination Survey I (1991\u20131992). 1992."},{"key":"3390_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-022-11913-2","volume":"12","author":"B Sakboonyarat","year":"2022","unstructured":"Sakboonyarat B, Poovieng J, Jongcherdchootrakul K, Srisawat P, Hatthachote P, Mungthin M, et al. Rising trends in obesity prevalence among Royal Thai Army personnel from 2017 to 2021. Sci Rep. 2022;12:1\u20138.","journal-title":"Sci Rep"},{"key":"3390_CR20","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1038\/s41598-023-28494-3","volume":"13","author":"B Sakboonyarat","year":"2023","unstructured":"Sakboonyarat B, Poovieng J, Jongcherdchootrakul K, Srisawat P, Hatthachote P, Mungthin M, et al. Rising trends in the predicted 10-year risk of cardiovascular diseases among Royal Thai Army personnel from 2017 to 2021. Sci Rep. 2023;13:1476.","journal-title":"Sci Rep"},{"key":"3390_CR21","doi-asserted-by":"crossref","unstructured":"Martins D, Tareen N, Pan D, Norris K. The relationship between body mass index and pulse pressure in older adults with isolated systolic hypertension. Am J Hypertens. 2002;15.","DOI":"10.1016\/S0895-7061(02)02269-0"},{"key":"3390_CR22","first-page":"188","volume":"27","author":"YY Wang","year":"2023","unstructured":"Wang YY, Yang S, Chen SW. Relationship between body mass index and pulse pressure in a non-diabetic population: evidence from a multicenter, cross-sectional study. Eur Rev Med Pharmacol Sci. 2023;27:188\u201398.","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"3390_CR23","doi-asserted-by":"crossref","unstructured":"Kang MG, Kim KH, Koh JS, Park JR, Hwang SJ, Hwang JY, et al. Association between pulse pressure and body mass index in hypertensive and normotensive populations in the Korea National Health and Nutrition Examination Survey V, 2010\u20132012. J Clin Hypertens. 2017;19.","DOI":"10.1111\/jch.12935"},{"key":"3390_CR24","doi-asserted-by":"publisher","first-page":"6946","DOI":"10.1038\/s41598-023-34023-z","volume":"13","author":"B Sakboonyarat","year":"2023","unstructured":"Sakboonyarat B, Poovieng J, Srisawat P, Hatthachote P, Mungthin M, Rangsin R, et al. Prevalence, awareness, and control of hypertension and associated factors among Royal Thai Army personnel in Thailand from 2017 to 2021. Sci Rep. 2023;13:6946.","journal-title":"Sci Rep"},{"key":"3390_CR25","first-page":"13","volume":"6","author":"P Hatthachote","year":"2019","unstructured":"Hatthachote P, Rangsin R, Mungthin M, Sakboonyarat B. Trends in the prevalence of obesity among young Thai men and associated factors: from 2009 to 2016. Mil Med Res. 2019;6:13.","journal-title":"Mil Med Res"},{"key":"3390_CR26","unstructured":"National Center for Health Statistics. Adult Alcohol Use Information: Glossary - Alcohol . 2018. https:\/\/www.cdc.gov\/nchs\/nhis\/alcohol\/alcohol_glossary.htm. Accessed 19 Jul 2022."},{"key":"3390_CR27","unstructured":"National Center for Health Statistics. Adult Tobacco Use Information: Glossary- Tobacco. 2017. https:\/\/www.cdc.gov\/nchs\/nhis\/tobacco\/tobacco_glossary.htm. Accessed 19 Jul 2022."},{"key":"3390_CR28","unstructured":"Homan TD, Bordes S, Cichowski E. Physiology, Pulse Pressure. StatPearls. 2021;30."},{"key":"3390_CR29","doi-asserted-by":"crossref","unstructured":"Benetos A, Safar M, Rudnichi A, Smulyan H, Richard JL, Ducimeti\u00e8re P, et al. Pulse pressure: A predictor of long-term cardiovascular mortality in a french male population. Hypertension. 1997;30.","DOI":"10.1161\/01.HYP.30.6.1410"},{"key":"3390_CR30","unstructured":"Ismail M, CL. T. WHO\/IASO\/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia: Melbourne. 2000."},{"key":"3390_CR31","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1186\/s12889-022-13992-2","volume":"22","author":"B Sakboonyarat","year":"2022","unstructured":"Sakboonyarat B, Poovieng J, Jongcherdchootrakul K, Srisawat P, Hatthachote P, Mungthin M, et al. Prevalence of hypertriglyceridemia among Royal Thai Army personnel and its related cardiometabolic risk factors, from 2017 to 2021. BMC Public Health. 2022;22:1569.","journal-title":"BMC Public Health"},{"key":"3390_CR32","doi-asserted-by":"crossref","unstructured":"Linden A, Mathur MB, VanderWeele TJ. Conducting sensitivity analysis for unmeasured confounding in observational studies using E-values: The evalue package. Stata Journal. 2020;20.","DOI":"10.1177\/1536867X20909696"},{"key":"3390_CR33","doi-asserted-by":"crossref","unstructured":"Miwa Y, Tsushima M, Arima H, Kawano Y, Sasaguri T. Pulse Pressure Is an Independent Predictor for the Progression of Aortic Wall Calcification in Patients with Controlled Hyperlipidemia. Hypertension. 2004;43.","DOI":"10.1161\/01.HYP.0000117153.48029.d1"},{"key":"3390_CR34","doi-asserted-by":"crossref","unstructured":"Liu F di, Shen XL, Zhao R, Tao XX, Wang S, Zhou JJ, et al. Pulse pressure as an independent predictor of stroke: a systematic review and a meta-analysis. Clin Res Cardiol. 2016;105.","DOI":"10.1007\/s00392-016-0972-2"},{"key":"3390_CR35","doi-asserted-by":"crossref","unstructured":"Dart AM, Kingwell BA. Pulse pressure - A review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001;37.","DOI":"10.1016\/S0735-1097(01)01108-1"},{"key":"3390_CR36","doi-asserted-by":"crossref","unstructured":"Mitchell GF. Arterial stiffness and hypertension. Hypertension. 2014;64.","DOI":"10.1161\/HYPERTENSIONAHA.114.00921"},{"key":"3390_CR37","doi-asserted-by":"crossref","unstructured":"Kwagyan J, Tabe CE, Xu S, Maqbool AR, Gordeuk VR, Randall OS. The impact of body mass index on pulse pressure in obesity. J Hypertens. 2005;23.","DOI":"10.1097\/01.hjh.0000160220.71350.5f"},{"key":"3390_CR38","doi-asserted-by":"crossref","unstructured":"Aroor AR, Jia G, Sowers JR. Cellular mechanisms underlying obesity-induced arterial stiffness. American Journal of Physiology - Regulatory Integrative and Comparative Physiology. 2018;314.","DOI":"10.1152\/ajpregu.00235.2016"},{"key":"3390_CR39","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1038\/nrendo.2014.44","volume":"10","author":"VG DeMarco","year":"2014","unstructured":"DeMarco VG, Aroor AR, Sowers JR. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014;10:364\u201376.","journal-title":"Nat Rev Endocrinol"},{"key":"3390_CR40","doi-asserted-by":"crossref","unstructured":"Jia G, Aroor AR, DeMarco VG, Martinez-Lemus LA, Meininger GA, Sowers JR. Vascular stiffness in insulin resistance and obesity. Front Physiol. 2015;6 Aug.","DOI":"10.3389\/fphys.2015.00231"},{"key":"3390_CR41","unstructured":"Institute of Medicine. Weight Management: State of the Science and Opportunities for Military Programs. In: Weight Management: State of the Science and Opportunities for Military Programs. 2004."},{"key":"3390_CR42","doi-asserted-by":"crossref","unstructured":"Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and diabetes study. Diabetes Care. 1997;20.","DOI":"10.2337\/diacare.20.4.537"},{"key":"3390_CR43","doi-asserted-by":"crossref","unstructured":"Peer N, Kengne AP. Tobacco cessation in low- and middle-income countries: some challenges and opportunities. Addiction. 2018;113.","DOI":"10.1111\/add.14214"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-023-03390-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-023-03390-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-023-03390-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T15:15:03Z","timestamp":1689693303000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-023-03390-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,18]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3390"],"URL":"https:\/\/doi.org\/10.1186\/s12872-023-03390-w","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,18]]},"assertion":[{"value":"27 March 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 July 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was reviewed and approved by the Institutional Review Board, Royal Thai Army Medical Department, according to international guidelines such as the Declaration of Helsinki, the Belmont Report, CIOMS Guidelines, and the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use\u2013Good Clinical Practice (ICH\u2013GCP) (approval number S056h\/65). As a result of using secondary data, a waiver of documentation of informed consent was utilized. The Institutional Review Board, Royal Thai Army Medical Department, approved an informed consent waiver.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Consent for publication is not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"361"}}