The Pattern of Blood Pressure Distribution and Analysis of Influencing Factors of Pre (Hypertension) Among Young Adults: A Cross-Sectional Survey in Western India

Rajanikant Solanki; Tejas Prajapati; Hasmukh Shah

doi:10.55489/njcm.141120233342

Authors

Rajanikant Solanki Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India https://orcid.org/0000-0003-0728-4344
Tejas Prajapati GMERS Medical College, Vadnagar, Gujarat, India https://orcid.org/0000-0002-1754-8801
Hasmukh Shah Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India https://orcid.org/0000-0003-4307-3552

DOI:

https://doi.org/10.55489/njcm.141120233342

Keywords:

Prehypertension, prevalence, non-communicable disease, young adults, India

Abstract

Background: Raised blood pressure is one of the significant preventable causes of cardiovascular diseases. The Global Burden of Diseases report 2019 has identified high systolic blood pressure as the leading risk factor for attributable deaths accounting for about 1.4 million deaths in India. The study aimed to determine the prevalence of prehypertension and hypertension, along with their associated risk factors, among young adults.

Methods: A cross-sectional study was conducted in urban science colleges in Gujarat. A multicomponent questionnaire comprised of demographic, dietary and lifestyle characteristics was administered to the participants (18-23 years). Data on weight, height and blood pressure were collected by trained field personnel. The categorical variables were tested by a chi-square test, while the t-test was used to compare quantitative variables.

Results: Overall, 415 participants (65% female) were included in the study, with a mean age of 19.5 years. The prevalence of prehypertension and hypertension was 23.4% and 4.8%, respectively. The multivariate analysis showed that the male gender, not being underweight, and overweight was found to be associated with elevated blood pressure.

Conclusions: There is a pressing need to identify cardiovascular risk factors at younger ages through regular screening, with more focus should be put on the adaptation of healthy lifestyles.

References

Arima H, Murakami Y, Lam TH, Kim HC, Ueshima H, Woo J, et al. Effects of Prehypertension and Hypertension Subtype on Cardiovas-cular Disease in the Asia-Pacific Region. Hypertension. 2012 ;59(6):1118-23. Doi: https://doi.org/10.1161/HYPERTENSIONAHA.111.187252 PMid:22547441

Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 ;396(10258):1223-49. Doi: https://doi.org/10.1016/S0140-6736(20)30752-2 PMid:33069327

World Health Organization. Global action plan for the prevention and control of noncommunicable diseases, 2013-2020. [Internet]. 2013 [cited 2022 Jun 17]. Available from: https://apps.who.int/iris/handle/10665/94384

World Health Organization. World health statistics 2021: monitoring health for the SDGs, sustainable development goals [Internet]. Geneva: World Health Organization; 2021 [cited 2022 Jun 17]. Available from: https://apps.who.int/iris/handle/10665/342703

International Institue for Population Sciences - IIPS/India, ICF. India national family health survey NFHS-5 -Gujarat 2019-21 [In-ternet]. Gujarat, Mumbai, India: IIPS and ICF; 2022. Available from: https://www.dhsprogram.com/pubs/pdf/FR374/FR374.pdf

Han M, Li Q, Liu L, Zhang D, Ren Y, Zhao Y, et al. Prehypertension and risk of cardiovascular diseases: a meta-analysis of 47 cohort studies. Journal of Hypertension. 2019 ;37(12):2325-32. Doi: https://doi.org/10.1097/HJH.0000000000002191 PMid:31335511

Kishi S, Teixido-Tura G, Ning H, Venkatesh BA, Wu C, Almeida A, et al. Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age. Journal of the American College of Cardiology. 2015 ;65(25):2679-87. Doi: https://doi.org/10.1016/j.jacc.2015.04.042 PMid:26112189

Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG, Russell M, et al. Cardiac and Systemic Hemodynamic Characteristics of Hyper-tension and Prehypertension in Adolescents and Young Adults: The Strong Heart Study. Circulation. 2007 ;115(2):221-7. Doi: https://doi.org/10.1161/CIRCULATIONAHA.106.668921 PMid:17210838

Deepika V, Vijayakumar R. Impact of Body Mass Index on Arterial Stiffness in Young Prehypertensives: A Cross Sectional Study. J Res Health Sci. 2017 ;18(1):e00402.

National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [Internet]. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2004 [cited 2022 Jun 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK9630/

Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991. 80 p.

World Health Organization. WHO STEPS Surveillance Manual. World Health Organization; 2020.

Rai RK, Kumar C, Singh PK, Singh L, Barik A, Chowdhury A. Incidence of Prehypertension and Hypertension in Rural India, 2012-2018: A Sex-Stratified Population-Based Prospective Cohort Study. Am J Hypertens. 2020 ;33(6):552-62. Doi: https://doi.org/10.1093/ajh/hpaa034 PMid:32149333

Ramakrishnan S, Zachariah G, Gupta K, Shivkumar Rao J, Mohanan PP, Venugopal K, et al. Prevalence of hypertension among Indian adults: Results from the great India blood pressure survey. Indian Heart Journal. 2019 ;71(4):309-13. Doi: https://doi.org/10.1016/j.ihj.2019.09.012 PMid:31779858 PMCid:PMC6890959

Peltzer K, Pengpid S, Sychareun V, Ferrer AJG, Low WY, Huu TN, et al. Prehypertension and psychosocial risk factors among univer-sity students in ASEAN countries. BMC Cardiovasc Disord. 2017 ;17(1):230. Doi: https://doi.org/10.1186/s12872-017-0666-3 PMid:28835205 PMCid:PMC5569482

Pletcher MJ, Bibbins-Domingo K, Lewis CE, Wei GS, Sidney S, Carr JJ, et al. Prehypertension during Young Adulthood and Coronary Calcium Later in Life. Ann Intern Med. 2008 ;149(2):91. Doi: https://doi.org/10.7326/0003-4819-149-2-200807150-00005 PMid:18626048 PMCid:PMC2587255

Tirosh A, Afek A, Rudich A, Percik R, Gordon B, Ayalon N, et al. Progression of Normotensive Adolescents to Hypertensive Adults: A Study of 26 980 Teenagers. Hypertension. 2010 ;56(2):203-9. Doi: https://doi.org/10.1161/HYPERTENSIONAHA.109.146415 PMid:20547973

Gyamfi D, Obirikorang C, Acheampong E, Danquah KO, Asamoah EA, Liman FZ, et al. Prevalence of pre-hypertension and hyperten-sion and its related risk factors among undergraduate students in a Tertiary institution, Ghana. Alexandria Journal of Medicine. 2018 ;54(4):475-80. Doi: https://doi.org/10.1016/j.ajme.2018.02.002

Reckelhoff JF. Gender Differences in the Regulation of Blood Pressure. Hypertension. 2001 ;37(5):1199-208. Doi: https://doi.org/10.1161/01.HYP.37.5.1199 PMid:11358929

Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: fram-ing the challenges to health. Lancet. 2019 ;393(10189):2440-54. Doi: https://doi.org/10.1016/S0140-6736(19)30652-X PMid:31155275

Lahole S, Rawekar R, Kumar S, Acharya S, Wanjari A, Gaidhane S, et al. Anthropometric indices and its association with hypertension among young medical students: A 2 year cross-sectional study. J Family Med Prim Care. 2022;11(1):281. Doi: https://doi.org/10.4103/jfmpc.jfmpc_1231_21 PMid:35309623 PMCid:PMC8930141

Guo X, Zou L, Zhang X, Li J, Zheng L, Sun Z, et al. Prehypertension: a meta-analysis of the epidemiology, risk factors, and predictors of progression. Tex Heart Inst J. 2011;38(6):643-52.

Parthaje PM, Unnikrishnan B, Thankappan KR, Thapar R, Fatt QK, Oldenburg B. Prevalence and Correlates of Prehypertension Among Adults in Urban South India. Asia Pac J Public Health. 2016 ;28(1_suppl):93S-101S. Doi: https://doi.org/10.1177/1010539515616453 PMid:26596285 PMCid:PMC4802005

Dutta M, Selvamani Y, Singh P, Prashad L. The double burden of malnutrition among adults in India: evidence from the National Fami-ly Health Survey-4 (2015-16). Epidemiol Health. 2019 ;41:e2019050. Doi: https://doi.org/10.4178/epih.e2019050 PMid:31962037 PMCid:PMC6976728

Nguyen PH, Scott S, Headey D, Singh N, Tran LM, Menon P, et al. The double burden of malnutrition in India: Trends and inequalities (2006-2016). Goli S, editor. PLoS ONE. 2021 ;16(2):e0247856. Doi: https://doi.org/10.1371/journal.pone.0247856 PMid:33630964 PMCid:PMC7906302

De Silva A, Rani M World Health Organization, Regional Office for South-East Asia. The double burden of malnutrition: priority ac-tions on ending childhood obesity [Internet]. 2020 [cited 2022 Jun 28]. Available from: https://apps.who.int/iris/handle/10665/336266

Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS, et al. The double burden of malnutrition: aetiological pathways and consequences for health. The Lancet. 2020 ;395(10217):75-88. Doi: https://doi.org/10.1016/S0140-6736(19)32472-9 PMid:31852605

Shetty PS. Nutrition transition in India. Public Health Nutr. 2002 ;5(1a):175-82. Doi: https://doi.org/10.1079/PHN2001291 PMid:12027282

Tak M, Shankar B, Kadiyala S. Dietary Transition in India: Temporal and Regional Trends, 1993 to 2012. Food Nutr Bull. 2019 ;40(2):254-70. Doi: https://doi.org/10.1177/0379572119833856 PMid:31006264

Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet. 2020 ;395(10217):65-74. Doi: https://doi.org/10.1016/S0140-6736(19)32497-3 PMid:31852602

Weltgesundheitsorganisation, FAO, editors. Diet, nutrition, and the prevention of chronic diseases: report of a WHO-FAO Expert Consultation ; [Joint WHO-FAO Expert Consultation on Diet, Nutrition, and the Prevention of Chronic Diseases, 2002, Geneva, Swit-zerland]. Geneva: World Health Organization; 2003. 149 p. (WHO technical report series).

Dyer A, Liu K, Walsh M, Kiefe C, Jr DJ, Bild D. Ten-year incidence of elevated blood pressure and its predictors: The CARDIA Study. J Hum Hypertens. 1999 ;13(1):13-21. Doi: https://doi.org/10.1038/sj.jhh.1000740 PMid:9928747

Singh S, Shankar R, Singh GP. Prevalence and Associated Risk Factors of Hypertension: A Cross-Sectional Study in Urban Varanasi. International Journal of Hypertension. 2017;2017:1-10. Doi: https://doi.org/10.1155/2017/5491838 PMid:29348933 PMCid:PMC5733954

Spring B, Moller AC, Colangelo LA, Siddique J, Roehrig M, Daviglus ML, et al. Healthy Lifestyle Change and Subclinical Atherosclerosis in Young Adults: Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circulation. 2014 ;130(1):10-7. Doi: https://doi.org/10.1161/CIRCULATIONAHA.113.005445 PMid:24982115 PMCid:PMC4615574

Reges O, Krefman AE, Hardy ST, Yano Y, Muntner P, Lloyd-Jones DM, et al. Decision Tree-Based Classification for Maintaining Normal Blood Pressure Throughout Early Adulthood and Middle Age: Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study. American Journal of Hypertension. 2021 ;34(10):1037-41. Doi: https://doi.org/10.1093/ajh/hpab099 PMid:34175929 PMCid:PMC8557418

Luo D, Cheng Y, Zhang H, Ba M, Chen P, Li H, et al. Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis. BMJ. 2020 ;m3222. Doi: https://doi.org/10.1136/bmj.m3222 PMid:32907799 PMCid:PMC7478061