International Journal of Current Research and Review
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IJCRR - 7(11), June, 2015

Pages: 44-49

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STUDY OF HYPERTENSION IN YOUTH AND ITS CONTRIBUTORY FACTORS - A CROSS
SECTIONAL STUDY OF 600 SUBJECTS

Author: Amrit M. Nasta, S. R. Raghuwanshi, Jayati J. Churiwala

Category: Healthcare

Abstract:=0Hypertension, a critical determinant of vascular disease and component of metabolic syndrome, remains scarcely studied in youth. Objectives:
1. To study the prevalence of hypertension in the age group 14-26years
2. To study its association with the variables- gender, stress, obesity, dietary habits, exercise, smoking, alcohol consumption, religion and family history of hypertension Methods: In this cross-sectional study, 600 individuals in the age group 14-26 years were enrolled from a metropolitan city. Prevalence of hypertension and its association with contributory variables was studied for 2 months. Hypertension was diagnosed
according to the Indian Academy of Pediatrics and Joint National Committee 7 guidelines. Data regarding contributory factors was collected on a pre-validated questionnaire. Statistical analysis was performed using Mann Whitney U test and Pearson's Chi square test. Binary logistic regression was performed to eliminate confounding factors. Results: The prevalence of prehypertension and hypertension in the age groups 14-18 years, 19-22 years and 23-16years was 40.5%, 45.5% and 53% respectively. 42.2% hypertensives belonged to the age group 23-26years. Of the prehypertensives and hypertensives, 77% were males; 8.3% obese; 54.7% admitted that they took stress; 66.5% had a family history of hypertension and 23% were alcohol consumers. No significant association was noted with smoking (p=0.071), religion (p=0.102), exercise and dietary pattern (p=0.452). Conclusion: Prevalence of hypertension in age group 14 to 26 years is 10.67% and prehypertension is 35.67% showing an increasing trend with age and a higher prevalence in males, obese and alcohol consumers

Keywords: Hypertension, Prehypertension, Youth, Obesity

Full Text:

INTRODUCTION

 Background: Hypertension is an important modifiable risk factor for coronary heart disease, stroke, congestive heart failure, end-stage renal disease, and peripheral vascular disease. Earlier thought to be a disease affecting mainly the elderly, it now has a firm grip on youth in developing countries like India. Rising affluence has modified dietary pattern characterized by increased consumption of fats and salt. Increasing population and technological advancement have shrunken employment opportunities among youth leading to stress and hypertension in the younger generation, including students. Alcoholism and smoking have become a trend among the youth. Sports and physical activity have decreased with the advent of gaming devices and smartphones. Such factors have led to a rise in hypertension in the youth. Thus, it becomes imperative to carry out a study on the prevalence of hypertension in youth and work towards lowering its incidence.

Objectives:

1. To study the prevalence of hypertension in the age group 14-26years

2. To study the association of hypertension with the variables- gender, stress, obesity, dietary habits, exercise, smoking, alcohol consumption, religion and family history of hypertension

MATERIAL AND METHODS

This study is cross sectional in design. 600 individuals belonging to the age group 14 to 26years were recruited from the metropolitan city of Mumbai. 200 students belonged to each of the age groups- 14 to 18years, 19 to 22years and 23 to 26years. They were randomly selected from a secondary school and junior college, a medical college and a tertiary health care institute respectively.

Inclusion Criteria:

1. Individuals consenting to participate in the study

2. Individuals belonging to the age groups under study

Exclusion Criteria:

1. Individuals not consenting for the study

2. Pregnant females

3. Patients diagnosed with secondary hypertension

After obtaining informed consent, a physical examination was performed and findings of blood pressure, anthropometry and general examination recorded. Personal details regarding stress, dietary habits, exercise regime, smoking, alcohol consumption, religion and family history of hypertension and cardiovascular disease were collected from each subject through a pre-validated questionnaire administered by volunteers. The study duration was two months.

Diagnosis of Hypertension:
Blood pressure was measured using a standardized calibrated column type mercury sphygmomanometer with appropriately sized cuff, on the right arm in seated posture with the instrument at the level of the heart. In cases where blood pressure was more than 140/90 mm of Hg, it was measured again after 30 minutes of rest. For children aged 14-17 years, hypertension was classified on the basis of guidelines of the Indian Pediatric Nephrology Group, Indian Academy of Pediatrics. Prehypertension was defined as systolic or diastolic blood pressure between the 90th and 95th percentile for age, gender and height. When blood pressure exceeded120/80 mm Hg in adolescents, but was below the 95th percentile, they were included in this category. Systolic or diastolic blood pressure exceeding the 95th percentile for age, gender and height was diagnostic of hypertension.1 In adults, hypertension was diagnosed as per the guidelines laid by the Joint National Committee 7 (Table 1). Individuals on medication for hypertension were also classified as hypertensives irrespective of blood pressure.

Psychological Stress:

The participants were asked if they took too much stress or tension. If the answer was ‘YES’, they were grouped as stressed.

Obesity:

Weight was measured on a standard bathroom weighing scale with clothes and without shoes.Height was measured on a standard wall-mounted chart with subject standing straight and head held in Frankfurt’s plane. Error due to subject’s hair was eliminated with the help of a flat board. Children aged 14-17 years were classified into underweight, normal, overweight and obese on the basis of charts published in the study titled ‘Physical Growth Assessment in Adolescence’ by KN Agrawal, A. Saxena, AK Bansal and DK Agrawal in June, 2001.3 Adults were classified similarly on the basis of the WHO guidelines based on their Body Mass Index (B.M.I.).

Physical Activity:

Individuals were classified into three categories depending on the duration of physical exercise

i) Those who did not perform any exercise

ii) Light exercise- individuals who performed any form of physical exercise for upto 2 hours per week

iii) Heavy exercise- individuals performing more than 2 hours per week of any form of physical exercise.

Smoking: Any amount of smoking habit was considered positive in our study.

Alcohol consumption: Males consuming more than or equal to 80g alcohol per day and females consuming more than 40g alcohol per day were considered to have a positive history of alcohol consumption based on a study by U Keil et al.4

Family History: Family history of hypertension was noted as positive if any first degree relative of the participant was a known hypertensive. Other aspects of general examination were done by routine methods.

All measurements were taken late in the afternoon or in the evening between 3 p.m. and 7 p.m.

Statistical Analysis:

1. Quantitative data:

a) Kolmogorov Smirnov test was used to check normality of data. A ‘p’ value of less than 0.05 suggests that the underlying data distribution is not normal.

b) As the underlying data distribution is non normal, Mann Whitney U test was applied to test the relationship of group and age.

2. Qualitative data:

Pearson’s chi-square test is used to test the relationship of categorised independent and dependent variable. To examine the relationship of each independent variable with the dependent variable, Binary Logistic Regression was performed. This procedure examines the above relationship after accounting for interaction and confounding. A ‘p’ value of < 0.05 is deemed statistically significant.

RESULTS

The study sample consisted of 200 individuals in each of the age groups 14-18years, 19-22years and 23-26years. 64.7% of the sample comprised of males and the rest were non-pregnant females. The prevalence of prehypertension and hypertension in the age groups 14-18, 19-22 and 23-26years was 40.5%, 45.5% and 53% respectively. 35.67% of the sample was found to be prehypertensive and 10.67% hypertensive (Table 2). Age, gender, BMI, stress, family history of hypertension and alcohol consumption were found to be statistically significant independent risk factors of hypertension in youth. The prevalence of hypertension and prehypertension shows an increase with age- in the age group 14 to 18 years it is 29.1%, in the group of individuals 19 to 22 years old it is 32.7% and amongst the age group 23 to 26 years it is 38.1% of the total hypertension and prehypertension group. 77% of the individuals in the prehypertensive and hypertensive age group are males. Among the group with deranged blood pressure, 8.9% are obese and 25.2% are overweight, and 54.7% admitted leading a stressful life. Family history is found to be significantly associated with hypertension with 66.5% having a positive history. Alcohol consumption was noted in 23% prehypertensive and hypertensive individuals. Smoking, found to be a significant risk factor on univariate analysis, was proved to be insignificant on performing binary logistic regression (p=0.071). Exercise (p=0.221), dietary habits (p=0.452) and religion (p=0.102) were statistically insignificant associations (Table 3).

DISCUSSION

The prevalence of hypertension in youth was found to be 10.67%. An increasing trend is evident with age rising from 8.5% in 14-18 year old individuals to 11.8% in 19- 26year olds. Another study carried out by Soudarssanane MB et al showed an increasing prevalence of hypertension with age in an urban Indian setting.5 A study conducted in the urban setting by Kath A. Moser et al on 10,671 subjects showed a prevalence of 13% amongst 18-30year old participants. This study also supports our result of an increasing prevalence with age.6 A prevalence of 10.1% was reported by PA Dyson et al (2014) in the age group 12-18years in India.7 R. Gupta et al (2009) reported a lower prevalence of hypertension among young Asian Indians of 1.4% in the age group 15- 19 years and 3.1% in the age group 20-29 years.8 Similarly D. Narayanappa et al conducted a prevalence study in 2012 on a group of school children 10-16 years old and reported a prevalence of prehypertension and hypertension as 2.9% and 2.8% respectively demonstrating and increasing trend with time.9 In our study, the prevalence of prehypertensives and hypertensives was comparatively higher in the male sex. 77% of the prehypertensive and hypertensive population were males. Gender was a significant risk factor for hypertension (Odds ratio 0.352). Similarly, the Framingham Offspring Study by Garrison RJ et al. also showed that men below 40 years of age were twice as likely to be hypertensive as women. A hormonal role is believed to be responsible for this difference. Body Mass Index was found to be a very significant risk factor for hypertension. In our study, from the total hypertensives and prehypertensives, 3.6% were underweight, 62.9% were normal, 25.2% were overweight and 8.3% were obese.PA Dyson et al reported a 3.5-5.5 times likelihood of obese children developing hypertension and 1.7-2.3 times probability for overweight children.7 A threefold increase in the risk of hypertension in obese children as compared to the non-obese has been reported by M. Salvadori et al.10Stress was found to be a very highly significant risk factor in our study (p< 0.0001, Odds ratio 1.867). 54.7% subjects admitted to taking too much stress. According to a study by Karen Matthews et al., 13 years of follow-up in a sample of >4100 normotensive black and white men and women showed a very high co-relation of stress and hypertension (p<0.0001 to <0.01).11 A study by Lijing L. Yan on 3308 individuals aged 18 to 30 years showed that stress in the form of time urgency/impatience (p= 0.001) and hostility (p< 0.001) were associated with a long term risk vof hypertension.12We report family history as a significant risk factor for hypertension (p< 0.0001, Odds ratio 2.31). Of the total prehypertensive and hypertensive subjects, 66.5% had a family history of hypertension. In our study, intake of alcohol was a significant risk factor (p= 0.048) for hypertension. From the total prehypertensive and hypertensive subjects, 23%were alcohol consumers.An attributable risk of 16% has been reported by a previous study to signify the role of alcohol consumption in the development of hypertension.13 Our study confirms a positive association. Smoking is not a significant risk factor for hypertension (p=0.071) in youth. This could be attributable to mass education programmes and the fact that youngsters do not have sufficient exposure to this habit. Lack of physical activity was not found to be a significant risk factor for hypertension in youth (p= 0.221). 46.8% subjects performed no exercise and 12.6% subjects exercised up to 2 hours per week. This is in contrast to the inverse association between physical activity and incidence of hypertension demonstrated in a longitudinal study over 20 years.14 Diet and religion were found to be insignificant risk factors in our study (p= 0.452, p= 0.102).

CONCLUSION:

The prevalence of hypertension in the age group 14 to 26 years is 10.67% and prehypertension is 35.67%. The prevalence of hypertension and prehypertension has shown an increase with age. Hypertension is more common in males than in females. It is associated with the Body Mass Index of a person, being more common in the overweight and obese. Stress is a highly significant risk factor for hypertension, the prevalence being high in individuals admitting to taking stress. There is a positive association between hypertension in youth and family history of hypertension. Personal habits like alcoholism show a small contribution to hypertension, while smoking shows no significant contribution. Physical activity, diet (vegetarian or mixed) and religion are insignificant risk factors of hypertension.

ACKNOWLEDGEMENTS:

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

1. National High Blood Pressure Education Programme Work- National High Blood Pressure Education Programme Working Group. The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics. 2004;114:555-76

2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, 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;289:2560– 2572

3. KN Agarwal, Saxena A, Bansal AK, S Agarwal DK. Physical Growth assessment in adolescence. Indian Pediatr 2001, 38: 1217-1235.

4. Keil U, Chambless L, Filipiak B, Härtel U. Alcohol and blood pressure and its interaction with smoking and other behavioural variables: results from the MONICA Augsburg Survey 1984-1985. J Hypertens. 1991 Jun;9(6):491-8.

5. 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 Journal of Community Medicine : Official Publication of Indian Association of Preventive and Social Medicine 2008;33(2):107-112. doi:10.4103/0970-0218.40879.

6. Moser KA, Agrawal S, Davey Smith G, Ebrahim S. SocioDemographic Inequalities in the Prevalence, Diagnosis and Management of Hypertension in India: Analysis of Nationally-Representative Survey Data. Guo Y, ed. PLoS ONE 2014;9(1):e86043. doi:10.1371/journal.pone.0086043.

7. Dyson PA, Anthony D, Fenton B, Matthews DR, Stevens DE. High rates of child hypertension associated with obesity: a community survey in China, India and Mexico. PaediatrInt Child Health.2014 Feb;34(1):43-9. doi: 10.1179/2046905513Y.0000000079

8. Gupta R, Misra A, Vikram NK, et al. Younger age of es- Gupta R, Misra A, Vikram NK, et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovascular Disorders 2009;9:28. doi:10.1186/1471-2261-9-28.

9. Narayanappa D, Rajani HS, Mahendrappa KB, Raviku- Narayanappa D, Rajani HS, Mahendrappa KB, Ravikumar VG. Prevalence of prehypertension and hypertension among urban and rural school going children. Indian Pediatr. 2012 Sep;49(9):755-6

10. Salvadori M, Sontrop JM, Garg AX, Truong J, Suri RS, Mahmud FH, et al. Elevated blood pressure in relation to overweight and obesity among children in a rural Canadian community. Pediatrics. 2008;122:e821–7.

11. Matthews KA, Katholi CR, McCreath H, Whooley MA, Wil- Matthews KA, Katholi CR, McCreath H, Whooley MA, Williams DR, Zhu S and Markovitz JH. Blood pressure reactivity to psychological stress predicts hypertension in the CARDIA study. Circulation 2004 11074–78. doi:10.1161/01. CIR.0000133415.37578.E4.

12. Lijing L. Yan, Kiang Liu, Karen A. Matthews, Martha L. Daviglus, T. Freeman Ferguson, Catarina I. Kiefe. Psychosocial Factors and Risk of Hypertension -The Coronary Artery Risk Development in Young Adults (CARDIA) Study. JAMA 2003;290(16):2138-2148. doi:10.1001/ jama.290.16.2138

.13. Puddey, I. B. and Beilin, L. J., ALCOHOL IS BAD FOR BLOOD PRESSURE. Clinical and Experimental Pharmacology and Physiology, 2006 33: 847–852. doi: 10.1111/ j.1440-1681.2006.04452.

14. Carnethon MR, Evans NS, Church TS, et al. Joint Asso- Carnethon MR, Evans NS, Church TS, et al. Joint Associations of Physical Activity and Aerobic Fitness on the Development of Incident Hypertension: Coronary Artery Risk Development in Young Adults (CARDIA). Hypertension 2010;56(1):49-55. doi:10.1161/HYPERTENSIONAHA.109.147603.

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A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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