Associations Among Dietary Patterns, Perceived Stress, and Hypertension: A Community-Based Path Analysis Study

Abstract

Introduction: Hypertension is a leading modifiable contributor to cardiovascular morbidity and mortality. Dietary patterns and psychosocial stress are interrelated determinants of hypertension, yet they are rarely examined simultaneously within community settings. Objective: To examine direct and indirect pathways linking dietary patterns and perceived stress with hypertension among community-dwelling adults using path analysis. Methods: A cross-sectional study was conducted among adults aged 30–65 years selected through multistage cluster sampling from community health center areas. Dietary intake was assessed using a validated 95-item Food Frequency Questionnaire to identify Prudent, Western, and Traditional dietary patterns. Perceived stress was measured with the PSS-10. Blood pressure was measured using standardized procedures; hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg or antihypertensive use. Associations were examined using bivariate analysis and structural equation modeling. Results: Among 250 participants (mean age 49.6±8.7 years; 57.2% female), hypertension prevalence was 38.8%. The Prudent pattern was inversely associated with blood pressure and stress, whereas the Western pattern showed positive associations (all p≤0.01). Path analysis showed that the Western pattern was positively associated with perceived stress (β=0.24, p=0.002) and hypertension status (β=0.29, p<0.001), while the Prudent pattern was inversely associated with hypertension status (β=−0.18, p=0.004). Conclusion: Western dietary patterns were associated with higher hypertension risk both directly and indirectly through perceived stress, while Prudent patterns showed protective associations.