Objective  To quantitatively assess interactive influences of socio-economic, behavioral risk, and health care behavioral factors on hypertension among adults and to provide evidences for prevention and control of hypertension.

  Methods  We conducted a face-to-face questionnaire survey and physical examination among 4 000 permanent urban and rural adult residents ( ≥ 18 years old) recruited at 19 disease surveillance settings in Shandong province with stratified random cluster sampling in March 2016. AMOS 17.0 software was adopted in data analyses using structural equation model.

  Results  Among the 3 800 participants with valid responses, the hypertension prevalence rate differed significantly by permanent residence (urban or rural region), sex, age, education, marital status and annual family income (all P < 0.05). Compared to that among the urban and female participants, the hypertension prevalence rate was significantly higher among the urban (28.2% vs. 4.2%) and the male (29.6% vs. 26.3%) participants (both P < 0.05). For the groups of participants at various ages and with different education, the highest prevalence rate of hypertension was observed among the group aged 55 – 66 years (51.5%) and the group with the education of primary school or lower (38.8%). The hypertension prevalence rate also differed significantly by smoking, preference for salty diet, leisure exercise, physical examination, body mass index (BMI), and waist-hip ratio (WHR) (all P < 0.05). In comparison with that among the nonsmokers and those not having salty diet, having periodic physical examination, the hypertension prevalence rate was higher among smokers (27.8% vs. 25.1%) and those having salty diet (31.5%), not having periodic physical examination (30.6% vs. 24.0%). Age and unhealthy living behavior as the two exogenous latent variables showed both direct and indirect effect on the latent variable hypertension, with the total effect values of 0.198 and 0.017. As an intermediate variable affecting other impact factors, somatotype had direct effect on hypertension, with an effect value of 0.107, and the two latent variable – social economic condition and healthy living behavior had indirect effect on hypertension through mediation of somatotype. Interactive effect of age and education and that of height and body weight on hypertension were observed, with the effect values of – 0.15 and 0.30, respectively.

  Conclusion  Somatotype, as a significant characteristics in the hypertensives, could mediates effects of other influencing factors on hypertension prevalence and unhealthy living behavior is an important risk factors of hypertension. Special attention should be paid to the effects of the two variables when conducting health promotion on hypertension prevention among community population.