|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 10
| Issue : 4 | Page : 82-86 |
|
A cross-sectional study of prehypertension among young adults residing in an urban area of South India
Bhagyalaxmi Sidenur1, Gowri Shankar2
1 Department of Community Medicine, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India
2 Department of Community Medicine, S. Nijalingappa Medical College, Hospital and Research Centre, Bagalkot, Karnataka, India
| Date of Submission | 17-Jun-2022 |
| Date of Decision | 03-Aug-2022 |
| Date of Acceptance | 17-Aug-2022 |
| Date of Web Publication | 8-Nov-2022 |
Correspondence Address:
Bhagyalaxmi Sidenur
Department of Community Medicine, Basaveshwara Medical College, JMIT Campus, Chitradurga - 577 502, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_16_22
Background: Early warning signs of prehypertension indicate a higher likelihood of developing hypertension later in life. Prehypertension was given a new classification in the Seventh Joint National Committee-7 report that distinguished it from hypertension that had already developed. Prehypertensive people were those with systolic blood pressure between 120-139 mmHg or diastolic between 80 and 89 mmHg.
Objectives: The objective of this study is to study the prevalence of prehypertension and the factors associated with it.
Materials and Methods: The current cross-sectional study was done in an urban field practice area of a medical college with a study population ranging from 20 to 40 years. The sample size was 420. The systematic random sampling method was used to select the subjects. Anthropometric measurements such as weight, height, waist, and hip circumference were recorded. Body mass index was categorized according to the South East Asian region (WHO). The institutional ethical board accepted the study protocol.
Results: About 51.6% of people had prehypertension. Prehypertension was most common in people between the ages of 35 and 40 (35.4%). Prehypertension was more common in males and was highest in class IV socioeconomic status (37.3%). When compared to sedentary employees, moderate workers have a higher frequency of prehypertension (68.6%).
Conclusion: Our study shows that prehypertension is becoming more common among young individuals in the age range of 20–40 years (51.6%), indicating that it is not an age-related condition.
Keywords: Joint National Committee-8, prehypertension, prevalence, young adults
How to cite this article:
Sidenur B, Shankar G. A cross-sectional study of prehypertension among young adults residing in an urban area of South India. MRIMS J Health Sci 2022;10:82-6 |
How to cite this URL:
Sidenur B, Shankar G. A cross-sectional study of prehypertension among young adults residing in an urban area of South India. MRIMS J Health Sci [serial online] 2022 [cited 2023 Oct 4];10:82-6. Available from: http://www.mrimsjournal.com/text.asp?2022/10/4/82/360577 |
| Introduction | |  |
Twenty to fifty percent of all fatalities are caused by hypertension, which is the most prevalent cardiovascular disease.[1]
The risks of coronary artery disease, congestive heart failure, and cerebrovascular disease are all increased by hypertension by a factor of 2, 4, and 7, respectively. It ranks seventh in industrialized countries and fourth in underdeveloped countries for causing early death. Hence, the 21st century's biggest public health issue is hypertension.[2]
Prehypertension is a warning indication that appears early in life and indicates the likelihood of developing hypertension later in life. The Joint National Committee's (JNC) seventh report proposed a new classification for prehypertension that distinguished it from developed hypertension. Prehypertensive people were those with systolic blood pressure between 120-139 mmHg or diastolic between 80 and 89 mmHg. This study found that even mildly high blood pressure increased cardiovascular risk, with each increment of 20/10 mmHg in SBP/diastolic blood pressure doubling the risk. The results showed that in those with prehypertension, the risk of cardiovascular disease increased when the burden of additional risk factors such as obesity, diabetes, and dyslipidemia increased.[3]
There was a roughly 30-fold increase in prevalence in the urban regions and a 10-fold increase in rural areas. Urbanization, alterations in lifestyle, such as an increase in salt consumption, stress, and sedentary behavior are all potential factors. This could be attributable to the epidemiological change that India is currently facing. To establish baseline characteristics that may be used to analyze future trends and develop preventative programs to enhance the health of the urban population, it is required to estimate the prevalence of hypertension in India's urban population.[4]
Because there is a lack of data on young individuals, and most research focus on hypertension in older adults and the elderly, young adults are assumed to be at low risk of acquiring hypertension. Blood pressure monitoring at a young age is a good technique to predict the development of hypertension later in life. It is crucial to prevent, recognize, and treat hypertension in adults between the ages of 20 and 40 to slow the disease's natural progression and delay outcomes including congestive heart failure, stroke, and Myocardial infarction (MI).[5]
Bagalkot, a city impacted by the irrigation dam's backwater, has undergone significant changes in its sociodemographic composition. The current study's urban field practice area has been classified as a resettlement area.[6] Therefore, this study was undertaken to estimate the prevalence of prehypertension and the factors determining it.
| Materials and Methods | | |
The current cross-sectional study was done in an urban field practice area of a medical college with a study population ranging from 20 to 40 years. According to a study done in Tamilnadu, India in 2013, the prevalence was 25.45%.[7] Hence, desired sample size was obtained by formula, N = 4PQ/L2, where P is prevalence of positive factor (25.45%), Q = 100 − P, L is allowable error (20% of P) = 4 × 25.45 × 74.55/(5.09) 2 = 293. Considering 10% data loss = 322 approximately. Hence, a total of 420 study subjects were included in the study.
People in the study population between the ages of 20 and 40 who had lived in the study area for more than 6 months were included, whereas those with known hypertension, pregnant women, people with congenital heart problems, and very ill patients were excluded. To address selection bias, the systematic random sampling method was used to select the subjects. A single investigator collected the information to prevent observer bias. Before the interview, participants provided written informed consent, and the study procedure was approved by the institutional ethical committee.
To gather data regarding the following parameters, a predesigned, pretested, semistructured questionnaire was created. Questionnaire included sociodemographic information, socioeconomic status and personal history. Anthropometric measurements such as weight, height, waist, and hip circumference were recorded. Body mass index (BMI) was categorized according to the South East Asian region (WHO).[8]
Cohen perceived scale was used to assess stress.[9]
In the sitting position, blood pressure was assessed using a standardized mercury sphygmomanometer and stethoscope. Three readings were taken in an interval of 3–5 min and the mean was calculated. Subjects were categorized according to JNC-8 classification.[10]
Statistical analysis
Data were entered into Microsoft Excel and then it was analyzed using the SPSS (trial version 20) Statistical package of social sciences, (IBM Corp., Armonk, Newyork, United states) and OpenEpi software (Open Epi, Emory university, Atlanta, Georgia, United states). Categorical variables were analyzed using Chi-square test. Confounding variables were controlled using regression analysis. A statistically significant P value was defined as 0.05, and a highly significant P = 0.001.
| Results | | |
Our study revealed that 75 study subjects out of 420 were hypertensive and 345 (82.1%) were normotensive. Hence, the prevalence of hypertension in the area studied was 17.9% and we have excluded hypertensive from further analysis considering only prehypertension as per the objectives.
Out of 420 study subjects, the majority of the study subjects 217 (51.6%) were prehypertensive, followed by stage 1 hypertension 64 (15.2%) and 11 (2.6%) subjects belonged to stage 2 hypertension [Table 1]. | Table 1: Distribution of study subjects according to the Joint National Committee 8 criteria
Click here to view |
This study revealed that the prevalence of prehypertension was highest among 35–40 years age group (35.4%) and lowest among those aged between 30 and 34 years (16.5%). The consistent rise in the prevalence of hypertension was found to be statistically significant (P = 0.03).
In the present study, the prevalence of prehypertension was more in males (59.4%) when compared to females (40.4%). Moreover, the result was statistically significant (P = 0.01).
It was observed that the prevalence of prehypertension was highest among socioeconomic class IV (37.3%), followed by class III (29.4%) and class V (22.1%). However, this was not statistically significant (P = 0.72).
Moderate workers have a high prevalence (68.6%) of prehypertension compared to sedentary (19.3%) and heavy workers (11.9%) and the result was statistically insignificant (P = 0.96).
The prevalence of prehypertension was more among subjects doing physical exercise (88.01%) compared to subjects not doing physical exercise (11.9%) and the result was statistically significant (P = 0.05).
Subjects consuming salted snacks (74.1%) had a high prevalence of prehypertension compared to the ones not consuming (24.1%). Apparently, this was insignificant (P = 0.23).
In the subjects who had stress, the prevalence of prehypertension was higher (67.7%) when compared to the subjects having no stress (32.2%). This result was insignificant (P = 0.23).
The prevalence of prehypertension was more in obese subjects (34.5%), followed by 31.3% in preobese and overweight (15.6%). The result was found to be highly significant (P < 0.001) [Table 2]. | Table 2: Association of sociodemographic characters with prehypertension
Click here to view |
Binary logistic regression analysis was done. It was observed that there was a 1.4 times higher risk of developing prehypertension in the age group of 30–40 years compared to 20–30 years (Odds ratio [OR] – 1.4 [95% confidence interval [CI]: 0.868–2.33] P = 0.16) and it was statistically insignificant. Females had a 2.4 times higher risk of developing prehypertension compared to males (OR – 2.4[95% CI: 1.237–3.870] P = 0.01) and it was statistically significant. The odds of developing hypertension were three times (OR – 2.8 [95% CI: 1.513–3.802] P < 0.001]) in subjects having a family history of hypertension compared to who did not have a family history and it was statistically highly significant. Sedentary workers had two times (OR – 2.36 [95% CI: 1.54–3.42] P = 0.5) and moderate workers had 1.8 times (OR – 1.8 [95% CI: 0.74–4.3] P = 0.1) higher risk of developing hypertension than heavy workers and it was not significant. The odds of developing hypertension among tobacco chewers were 3.2 times more compared to nontobacco chewers (OR – 3.2 [95% CI: 1.62–5.59] P < 0.001) and it was statistically significant. Subjects having stress had 2.3 times more chances of developing hypertension (OR – 2.3 [95% CI: 1.770–4.91] P = 0.03) compared to subjects not having stress and it was statistically significant. The odds of developing hypertension were 3.4 times more in obese subjects (OR – 3.4 [95% CI: 1.49–7.11] P = 0.003) compared to subjects having normal BMI and it was statistically significant. Subjects consuming salted snacks had 2.3 times more chances of developing hypertension (OR – 2.3 [95% CI: 1.45–4.30] P = 0.02) than who were not consuming and it was statistically significant [Table 3]. | Table 3: Results of binary logistic regression analysis of independent risk factors with prehypertension
Click here to view |
| Discussion | | |
Our study showed the prevalence of prehypertension among young adults was 51.6%. According to a study conducted in a coastal region of Udupi, prehypertension was present in 45.2% of people.[11] Another study done in an urban area of Mysuru showed the prevalence of prehypertension to be 33.7%.[12] This difference may be due to urbanization, lifestyle changes, and dietary changes.
In our study, the prehypertension was highest among the 35–40 years age group (27%) and lowest among those aged between 30 and 34 years (16.3%). They were at a 1.5 times higher risk of developing prehypertension in the 30–40 years compared to the 20–30-year-old age group. A study done in Mangaluru shows a higher proportion of prehypertension belonged to 20–39 years (40.5%).[13] The findings of the above studies were similar to the present study which showed that as age increases, the prevalence of prehypertension increases. This probably is due to an accumulation of environmental influences and effects of environmental senescence in the body.
In the present study, the prevalence of prehypertension was more in males (59.4%) when compared to females (40.4%). Males were at 2.5 times higher risk of developing prehypertension compared to females. A similar finding was seen in a study done in a coastal area of Udupi stated that the prevalence of prehypertension was more in males (58%) compared to females (36.5%).[11] This could be attributed to the protective effect of estrogen in females in this age group or due to stress factors in males.
The prevalence of prehypertension in our study was more among socioeconomic status class IV (37.3%), followed by class III (29.4%). A similar finding was seen in a study done in Mysuru city which showed that the prevalence of prehypertension was more among socioeconomic status class IV (31.8%).[12] In contrast, a study done in Udupi showed that the prevalence of prehypertension was more among the middle class (85.2%).[11] This finding could be attributed to the fact that the majority of the study population were unemployed and were under stress.
In our study, moderate workers have a high prevalence (68.6%) of prehypertension followed by sedentary workers (19.3%). A similar finding was seen in a study done in an urban area of Nainital showed the prevalence of prehypertension was more among moderate workers (38%).[14] This could be due to a lack of physical activity and obesity.
The present study showed that the subjects consuming salted snacks (74.1%) had a high prevalence of prehypertension compared to the ones not consuming (24.1%). Subjects consuming salted snacks had two times the risk of developing prehypertension compared to ones not consuming.
A similar finding was seen in a study done in Mysuru city showed that subjects using extra salt at meals has a high prevalence of prehypertension (79.4%).[12] The high prevalence of pre-hypertension was more in subjects using extra salt could be due to the presence of sodium in a variety of processed foods and also in a sodium glutamate which is a food additive. Increased Extracellular volume (ECV) due to sodium retention results in increased cardiac output and tissue perfusion that exceeds metabolic requirements. The peripheral tissue vasculature reacts by turning on autoregulatory vasoconstriction, which raises peripheral resistance even more.[15]
In our study, the prevalence of prehypertension was higher (67.7%) among subjects with stress when compared to the subjects having no stress (32.2%). They were two times more at risk of developing prehypertension compared to subjects with no stress. A similar finding was seen in a study done in a coastal area of Udupi which shows that prehypertension was more among subjects with stress (83.5%) compared to subjects not having stress (16.5%).[11] This could be attributed to chronic stress which is known to activate sympathetic activity leading to hypertension.[16] Yoga and meditation can be introduced in the community to relieve stress.
The present study shows that the prevalence of prehypertension was more in obese subjects (34.5%), followed by 31.3% in preobese and overweight (15.6%). In contrast, a study done in the coastal area of Udupi showed that the prevalence of prehypertension was more in subjects having normal BMI (62.8%), followed by preobese (16.9%) and obese (3.8%).[11]
Since our study was a community-based study, our results can be generalizable and the external validity of the study is high. All the data in the study were collected by a single investigator. Hence, the observer bias can be ruled out.
The limitation of our study was more number of females was present in the study because the male population was not available at the time of data collection as they were out of the house for their job, while the majority of the female population were housewives and were available at the time of data collection.
| Conclusion | | |
Our study shows that prehypertension is becoming more common among young individuals in the age range of 20–40 years (51.6%), indicating that it is not an age-related condition. To implement prevention techniques to reduce the risk of cardiovascular illnesses, studies to determine the prevalence of prehypertension and hypertension are required in developing nations.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Park K. Park's Textbook of Preventive and Social Medicine. 24 th ed. Jabalpur: Banarsidas Bhanot; 2015. p. 391-2,682-4.  |
| 2. | Deepa R, Shanthirani CS, Pradeepa R, Mohan V. Is the 'rule of halves' in hypertension still valid? – Evidence from the Chennai urban population study. J Assoc Physicians India 2003;51:153-7. |
| 3. | Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., 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;289:2560-72. |
| 4. | Pradeepa R, Mohan V. Hypertension & pre-hypertension in developing countries. Indian J Med Res 2008;128:688-90. [ PUBMED] [Full text] |
| 5. | Tadvi AY, Bandi JR. Study of prevalence of hypertension in young adult population of age group 20 to 40 years in an urban slum of Mumbai, Maharashtra, India. Int J Community Med Public Health 2016;3:3325-31. |
| 6. | |
| 7. | Jayanthi R, Girijasivam SP, Nithyavikasini N, Gaur A. Prevalence of prehypertension in young adults in South India. Natl J Physiol Pharm Pharmacol 2020;10:961. |
| 8. | |
| 9. | Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring Stress: A Guide for Health and Social Scientists. Mind garden, Inc. California, United states; 1994. |
| 10. | |
| 11. | Kini S, Kamath VG, Kulkarni MM, Kamath A, Shivalli S. Pre-hypertension among young adults (20-30 Years) in coastal villages of Udupi district in Southern India: An alarming scenario. PLoS One 2016;11:e0154538. |
| 12. | Rajegowda RM, Nagaraj S, Nagaralu A. Prevalence of pre-hypertension among the urban population of Southern India. Natl J Community Med 2017;8:622-6. |
| 13. | 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;28:93S-101S. |
| 14. | Jha SK, Semwal V, Rawat CM, Ahmad S, Kumar S, Kaur A. Prevalence and determinants of prehypertension and hypertension among adults in an urban area in Haldwani city of Nainital: A population based cross-sectional study. Indian J Prev Soc Med 2015;46:7. |
| 15. | Drenjančević-Perić I, Jelaković B, Lombard JH, Kunert MP, Kibel A, Gros M. High-salt diet and hypertension: Focus on the renin-angiotensin system. Kidney Blood Press Res 2011;34:1-11. |
| 16. | Spruill TM. Chronic psychosocial stress and hypertension. Curr Hypertens Rep 2010;12:10-6. |
[Table 1], [Table 2], [Table 3]
|
Search Pubmed for