32 Original article: A study on the prevalence of

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