International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 Original article: A study on the prevalence of hypertension among young adults in a coastal district of Karnataka, South India Reddy VS1, Jacob GP2, Ballala K3, Ravi C4, Ravi B5, Gandhi P6, Tadkal P7, Singh T8 1Intern, 2Associate Professor, 3-8Assistant Professor – Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal – 576104 Corresponding Author: Dr. George P. Jacob, Associate Professor, Dept. of Community Medicine, Kasturba Medical College, Manipal University, Manipal – 576104, India Abstract: Background: Young adults are largely overlooked in studies on hypertension as they are deemed to be at a low risk of developing the disease. Study of disease prevalence and socio-demographic variables provide the insight required to develop interventional strategies. Objectives: 1. To estimate the prevalence of Hypertension among young adults in Udupi District, Karnataka. 2. To study the socio-demographic variables associated with hypertension including age, sex, socio-economic status, Body Mass Index, dietary habits, tobacco use and alcohol consumption. Method: Data were obtained from 413 college students aged 18 years and older by a cross-sectional survey in selected degree college. Relevant clinical parameters were collected (blood pressure recordings and anthropometric measurements) as well as socio-demographic characteristics. Results: Hypertension was detected in 29 of the 407 subjects (7.1%), of which the majority were newly diagnosed (75.9%). Prevalence among men was higher (15.0% compared to 4.8% among women). A total of 46.7% of the students were found to have pre-hypertension. While 35.5% of studentswho were pre-obese or obese had high BP recordings, the same was found in only 7.1% of those in the normal weight range. Higher prevalence of hypertension was seen among those with a history of smoking or alcohol consumption. Conclusion: Most of the young adults with blood pressure were previously undiagnosed. A large number of students had prehypertension. Their early identification facilitates early, active management of blood pressure and formulation of preventive strategies thereby minimizing complications. Key Words: Hypertension, Young adults, Body Mass Index Introduction: Statistics Report 2012, a third of the world’s adult Cardiovascular diseases are the leading cause of population has raised blood pressure – a condition death globally, accounting for approximately 31 responsible for half of all deaths from stroke and percent of all global deaths. Of these 17.5 million, 7.4 heart disease. Hypertension contributes to 4.5 percent million were due to coronary heart disease and 6.7 of the current global disease burden.2 In Asian urban million were due to stroke. Increased blood pressure adult populations, the prevalence of hypertension has is one of the important risk factors of cardiovascular shown an upward trend, at present varying between 1 disease. According to the WHO’s World Health 15-35 percent, with hypertension and stroke 32 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 occurring at a relatively younger age.3 Young adults Treatment of High blood Pressure9, as there is a have been deemed to be lower risk in their paucity in data regarding hypertension in this age development of hypertension, with resultant gaps in group, the literature on hypertension which typically target demographic variables associated with hypertension older adults and the elderly. The prevalence of had also been collected in order to identify potential hypertension among younger individuals, however, is interventions. on a steady rise. This may be attributed to several Materials and Methods: factors such as dramatic changes in lifestyle and This cross-sectional survey of students of selected stress patterns, improved detection rates due to better degree colleges over the age of 18 years was 4 particularly in this area. The socio- screening and a high prevalence of metabolic and conducted in rural and urban areas in the Udupi dietetic coronary risk factors among adolescents of district of coastal Karnataka, India. A total of 460 the middle- and upper-middle class. 5 students elected to participate and were administered The capacity for management of hypertension has the survey questionnaire at random, of which 413 varied widely among countries. Over 80 percent of participated in the study. cardiovascular deaths in developing countries have Sample size Estimation: Using the formula for been a result of a lack of widespread diagnosis and infinite population, treatment as compared to developed countries. In N = Z2pq the sample size is calculated where India, the incidence of cardiac disease is expected to d2 rise in parallel with the increase in life expectancy Z= normal deviate corresponding to the required CI secondary to increases in per capita income and (1.96 for 95% CI) 6 declining infant mortality. Within India, there has p= anticipated prevalence, taken as 10 based on been a greater prevalence of cardiovascular diseases literature available.4 in urban centres.7 The attention and resources q = (100-P) = 90 (100-10) provided to the area of communicable diseases alone d= required relative precision of the estimate, set at in the past has shifted in recent times to 30%. 30% allowable error of p was 3. accommodate rising trends in and to tackle non- The sample size was estimated to be 385. communicable Considering a non-response rate of 20 percent, the diseases including hypertension, stroke and coronary artery disease. In order to final sample size of 462 was reached. effectively however, Sampling and data collection: One college each community surveys from heterogeneous regions and from the rural and urban areas was randomly populations are needed to inform national level selected. Students from colleges situated in urban and policies. 8 manage these trends, The primary aim of this study was to rural areas were equally distributed. Also, an equal determine the prevalence of hypertension among proportion of males and females were chosen. All young adults in both rural and urban areas within a eligible students in the respective colleges were district of coastal Karnataka according to the JNC- chosen randomly until we met the required sample VII criteria (The Seventh Report of Joint National size. Clearance was obtained from our institutional committee on Prevention, Detection, Evaluation and ethical committee and the concerned college 33 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 authorities following which written informed consent was calculated as the ratio of waist circumference was taken prior to the administration of semi- over hip circumference. structured questionnaires to the selected students. Diagnostic Criteria: Part of the questionnaire was filled in by the students 1. Hypertension: and the rest by the investigator following the A student was considered hypertensive if he/she had necessary physical examination. been previously diagnosed and/or on treatment OR if Method of measuring blood pressure: Blood the systolic blood pressure was ≥ 140 mm of mercury pressure (BP) was measured using the auscultatory or diastolic blood pressure was ≥ 90 mm of mercury method with a standardized calibrated mercury at the time of measurement (JNC-VII criteria).(9) sphygmomanometer with adult cuff size. The 2. Obesity: 10, 11 measurement was taken on the right arm with the A BMI of ≥ 25 kg/m2 was recorded as ‘overweight’ subject in the sitting posture, with feet on the floor and BMI ≥ 30 kg/m2 as ‘obese’. Waist hip ratio of >1 and arm supported at heart level. The first appearance for males and > 0.85 for females were designated as of sound (phase I of Korotkoff sounds) was taken as Truncal obesity while waist circumferences of ≥ 94 the systolic blood pressure and the disappearance of cm in males and ≥ 80 cm in females were designated sound (phase V) was taken as the diastolic blood as Central or Abdominal obesity. pressure. Those found to have hypertension were Data analysis: SPSS (Statistical Package for Social informed about their blood pressure status and were Sciences) version 15 (insert citation here) was used suggested precautionary measures and they were for the tabulation and analysis of the collected data. advised to meet a physician for further management. Proportions and their 95% confidence intervals (CI) Anthropometric was were reported. Chi-square tests were applied to study recorded to the nearest 100 gm using a standard the relationship between different variables and weighing scale. Height was measured using a hypertension. measuring tape to the nearest 0.1 cm. Students were Results: requested to stand upright without footwear with their During the study 460 questionnaires were distributed. heels together and their back against the wall. BMI Of them, 413 filled up the questionnaire and 407 was calculated using the formula, Weight (kg) / students were physically examined. Nearly 70% of measurements: Weight 2 Height (m ). the students were between 18 and 19 years and over Waist circumference was measured to the nearest 0.1 95% were under 21 years. The proportion of males cm at the mid-point between coastal margin and iliac (47.7%) and females (52.3%) was comparable, as crest using a measuring tape at the end of normal was the proportion of rural (49.2%) and urban expiration with the subject standing erect in a relaxed (50.8%) participants (Table 1). Hypertension was position, feet 25-30 cm apart. Hip circumference was detected in 29 of the 407 subjects (prevalence=7.1%), measured at the level of the greater trochanters of which the majority were newly diagnosed (76%). (widest portion of the hip) to the nearest 0.1 cm by a The prevalence among men (15.0%) was higher as measuring tape, while the subject stood with their compared to women (5.0%; Table 2). In addition, arms by their side and feet together. Waist-hip ratio 46.7% of the subjects were found to have blood 34 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 pressures in the pre-hypertensive range (Table 3). On significant relation was found between high blood classification of the subjects according to their BMI, pressure recordings and additional salt intake (Table the prevalence of hypertension was the most among 5). A higher prevalence was found among students the obese (40%) and the pre-obese (37.5%), with with history of smoking (15.7%) and alcohol intake only 7.1% of those in the normal weight range having (14.3%) as compared to prevalence among the high blood pressures (p < 0.0001; Table 4). No remaining students (6.5%; Table 6). Table 1: Characteristics of the study participants Variable Age in years (n = 413) 18-19 20-21 22-23 24-25 Sex (n = 413) Male Female Course (n = 413) BA BCA BCOM Religion (n = 412) Hindu Christian Muslim Diet (n = 406) Vegetarian Mixed Area (n = 406) Urban Rural Number Percentage 288 107 15 3 69.8 25.9 3.6 0.7 197 216 47.7 52.3 197 137 79 47.7 33.2 19.1 304 89 19 73.8 21.6 4.6 70 336 17.2 82.8 210 203 50.8 49.2 Table 2: Prevalence of Hypertension Sex Number of students examined 197 Male 210 Female 407 Total X2 = 7.02, p= 0.071 Number of students with Hypertension Prevalence of Hypertension in % (95% CI) 19 10 29 15.0 4.8 7.1 (4.6-9.6) 35 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 Table 3: Classification of Blood Pressure according to JNC- VII criteria 9 Blood Pressure # of cases Normal Pre-hypertension Stage 1 Hypertension 188 190 23 Prevalence (%) 46.2 46.7 5.7 Stage 2 Hypertension Total 6 407 1.5 100 Table 4: Prevalence of hypertension according to the Body Mass Index Body Mass Index Number of students examined No. of students with Hypertension Prevalence of hypertension (%) Underweight Normal Pre-obese Obese class 1 Obese class 2 Obese class 3 Total 135 241 24 5 2 0 407 1 17 9 2 0 0 29 0.7 7.1 37.5 40 0 0 7.13 Table 5: History of additional salt intake among study participants Additional salt intake Number of students examined Present Absent Total X2 =3.58, p= 0.312 117 285 402 No. of students with hypertension 4 25 29 Prevalence of hypertension (%) 3.4 8.8 7.2 Table 6: Hypertension among students with history of smoking and alcohol intake History of smoking Present Absent Total X2 =4.18, p =0.242 History of alcohol intake Present Absent Total Number of students examined Number of students with hypertension Prevalence of Hypertension (%) 19 383 402 3 25 28* 15.7 6.5 6.96 21 382 403 3 25 28* 14.3 6.5 6.9 X2=3.26, p =0.340 *Data of one hypertensive student missing. 33 36 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 Table 7: Proportion of students newly diagnosed with hypertension No of students examined No. of students with hypertension Previous diagnosis 29 (7.1%) 407 Newly diagnosed 7 22 Discussion: pressure.20 Significant relationships between high The persistence of elevated childhood and adolescent dietary salt intake, alcohol consumption or smoking blood pressure and its progression into adult and hypertension were not found among the hypertension has been demonstrated in the past. participants of our study. Repeated high BP measurements in adolescence are a Conclusion: 12 predictor of adult hypertension. Blood pressure Hypertension was found to be a problem among monitoring in young adults is therefore useful for the young adults. Most of the cases were previously early detection and management of hypertension. undiagnosed. High prevalence of hypertension was found among hypertensive needs regular follow-up. Their early the young adults in our study. Similarly, high rates identification facilitates early, active management of have been demonstrated in earlier studies on young their hypertension thereby minimizing complications 13 adults as well as in teenagers. 18 The large proportion of pre- About half of the such as cardiovascular changes and end organ remaining sample was found to be pre-hypertensive, damage later in life. Further studies need to be illustrating the necessity of monitoring blood conducted as there is paucity in data on hypertension pressure in this age group. in the young adult population of this area in order to Prior studies have attempted to describe factors formulate preventive strategies at all levels. associated with development of hypertension in Acknowledgements: we deeply acknowledge the young adults. The most important relation was found subjects who took part in the study and Dr. Asha between obesity and hypertension. Obesity indicators Kamath for statisticial help. (BMI, WHR and waist circumference) have been Funding: Indian Council of Medical Research repeatedly proven to possess a significant positive Ethics Committee Approval: Institutional Ethics correlation with both elevated systolic and diastolic Committee, Kasturba Medical College, Manipal blood pressures hypertensive 13-17, than 19 Men are more often women 13,14 attributable to University. Approval reference number: IEC 270/2011 differences in the hormonal regulation of blood References: 1. WHO Fact Sheet. Cardiovascular diseases. World Health Organization; January 2015. No. 317. 2. World Health Organization, International Society of Hypertension Writing Group. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension.Journal of Hypertension. 21(11):1983-1992, November 2003. 37 34 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 3. Singh RB, Suh IL, Singh VP, Chaithiraphan S, Laothavorn P, Sy RG, et al. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention. J Hum Hypertens. 2000 Oct-Nov;14(1011):749-63. 4. Soudarssanane M, Mathanraj S, Sumanth M, Sahai A, Karthigeyan M. Tracking of blood pressure among adolescents and young adults in an urban slum of Puducherry.Indian J Community Med. 2008 Apr;33(2):107-12. 5. Gupta R, Goyle A, Kashyap S, Agarwal M, Consul R, Jain BK. Prevalence of atherosclerosis risk factors in adolescent school children.Indian Heart J. 1998 Sep-Oct;50(5):511-5. 6.Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation. 1998; 97: 596–601 7. Gupta R, Gupta VP. Meta-analysis of coronary heart disease prevalence in India. Indian Heart J. 1996; 48: 241– 245. 8. Das SK, Sanyal K, Basu A. Study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country.Int J Med Sci. 2005; 2 (2):70-78. 9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.JAMA. 2003 May 21; 289 (19):2560-72. 10. Report of World Health Organization consultation. Obesity: preventing and managing the global epidemic. Geneva, Switzerland: World Health Organization; 2000. WHO Tech Rep Ser. No.894. 11. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995; 311: 158-61 12. Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthoos: The Bogalusa Heart Study. Am Journal of Hypertension. 1995 July; 8 (7): 657-665. 13. Rosenthal J.The epidemiology of blood pressure in young Mexican adults.J Hypertens. 1989 May;7(5):355-60. 14. Ennis IL, Gende OA, Cingolani HE. Prevalence of hypertension in 3154 young students.Medicina (B Aires). 1998;58(5 Pt 1):483-91. 15. Tokyo.Uehara Y, Miyazaki M, Kanase H, Sugano K, Toyo-Oka T.Body mass index is a determinant of blood pressure in young adults with essential hypertensive parents. Health Care Programme of University of Tokyo.J Hum Hypertens. 1996 Sep;10(9):601-6. 16.Singh RB, Beegom R, Ghosh S, Niaz MA, Rastogi V, Rastogi SS, Singh NK, Nangia S. Epidemiological study of hypertension and its determinants in an urban population of North India.J Hum Hypertens. 1997 Oct;11(10):67985. 17.Goel R, Misra A, Agarwal SK, Vikram N. Correlates of hypertension among urban Asian Indian adolescents.Arch Dis Child. 2010 Dec;95(12):992-7. 18. Dimkpa U, Oji JO. Relationship of body mass index with haemodynamic variables and abnormalities in young adults.J Hum Hypertens. 2010 Apr;24(4):230-6. 38 33 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research , Volume: 03, Issue: 03 , April 2015 , Pages 32-39 19. Deshmukh PR, Gupta SS, Dongre AR, Bharambe MS, Maliye C, Kaur S, Garg BS. Relationship of anthropometric indicators with blood pressure levels in rural Wardha. Indian J Med Res. 2006 May;123(5):657-64. 20. Reckelhoff JF. Gender differences in the regulation of blood pressure.Hypertension.2001; 37: 1199-1208. 39 34 www.ijhbr.com ISSN: 2319-7072
© Copyright 2024