Prevalence and determinants of prehypertension and hypertension among adolescents: a school based study in a rural area of Kerala, India
Keywords:
Prehypertension and hypertension, Adolescents, Rural KeralaAbstract
Background:Raised blood pressure is the leading cause of death and disability world-wide. Though hypertension is a problem of adults the aetiologic process and risk behaviours start early in life. The objective of the study was to assess the prevalence and determinants of prehypertension and hypertension among adolescents from high schools in a rural area of Kerala, India.
Methods:A cross sectional analytical study was carried out in 1000 adolescents from randomly selected Government, Aided and Unaided high schools of Ettumanoor, Kerala proportionate to sampling frame using WHO designed Global School based student Health Survey (GSHS) questionnaire. Anthropometry and blood pressure recordings were done by trained team members. Statistical analysis was done using SPSS 21. Chi-square test was used to find out the association between categorical variables. Significant variables were entered into logistic regression model to find out Adjusted Odds Ratio (AOR).
Results:Out of 1000 study subjects, 409(40.9%) were males and 591(59.1%) were females. Overall prevalence of prehypertension and hypertension was 24.5% (males-30.5%, females-20.3%) and 0.6% (males-0.98%, females-0.34%) respectively. Male sex (AOR-1.67 95%CI-1.23-2.28), low socio-economic status (AOR-1.55 95%CI-1.15-2.11), overweight/obese (AOR-5.7 95%CI- 2.4-13.6), low fruit consumption (AOR-2.02 95% CI-1.499-2.7) and high soft drink consumption (AOR-2.21 95%CI- 1.446-3.39) were the significant risk factors for prehypertension and hypertension.
Conclusion:Male sex, Low socio-economic status, obesity/overweight, low fruit and high soft drink consumption are the significant determinants of Pre hypertension and hypertension among adolescents. The findings may be used in developing messages to provide awareness of dangers of raised blood pressure among adolescents and its behavioural determinants.
References
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet. 2013;380:2224-60.
Reddy KS, Shah B, Varghese C, Ramdoss A. Responding to the threat of chronic diseases in India. Lancet. 2005;366:1744-9.
Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, et al. Chronic diseases and injuries in India. Lancet. 2011;377:413-28.
WHO. Health needs of adolescents. Report of a WHO Expert Committee. Geneva, World Health Organization, 1977 (WHO Technical Report Series, No. 609). Available at: whqlibdoc.who.int/trs/WHO TRS 609.pdf.
Chadha SL, Vasan RS, Sarma PS, Shekhawat S, Tandon R, Gopinath N. Age and height specific reference limits of blood pressure of Indian Children. Natl Med J India. 1999;12(4):150-6.
Lawlor DA, Smith GD. Early life determinants of adult blood pressure. Curr Opin Nephrol Hypertens. 2005;14(3):259-64.
Sung RYT, Lam YM, Leung SSF. Blood pressure in Hong Kong Chinese children: correlation with anthropometric data. JHK Coll Cardiol. 1994;2:99-106.
Luma GB, Spiotta RT. Hypertension in children and adolescents. Am Fam Physician. 2006;73:1558-68.
de Onis M, Blossner M. Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr. 2000;72:1032-9.
World Health Organization. Mortality estimates by cause, age and sex for the year, 2008. Available at: www.who.int/health info/ global burden disease/en/. Accessed 29 April 2014.
Thankappan KR, Bela Shah, Prashant Mathur, Sarma PS, Srinivasa G, Mini GK, et al. Risk factor Profile for chronic non-communicable diseases: results of a community based study in Kerala, India. Indian J Med Res. 2010 Jan;131:53-63.
Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S, Sood NK, et al. Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J. 2004;56:310-4.
National High Blood Pressure Education Programme Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Paediatrics. 2004;114:555-76.
Akhil Kant Singh, Ankit Maheswari, Nidhi Sarma, K. Anand. Lifestyle associated risk factors in adolescents. Indian J Paediatr. 2006;73(10):901-6.
Rohan Raosaheb Patel, Bishan Swarup Garg. Prevalence of hypertension and variation in blood pressure among school children in rural area of Wardha. Indian J Public Health. 2014;58(2):78-83.
Percy C, Freedman DS, Gilbert TJ, White L, Ballew C, Mokhad A. Prevalence of hypertension among Navajo Indians: finding from the Navajo and nutritional survey. J Nutr. 1997;127(10):2114S-9S.
Sugarman JR, White LL, Gilbert TJ. Evidence for a secular change among Navajo Indian school children. Am J Clin Nutr. 1990;52(6):960-6.
Mendelsohn ME, Karas RH. The protective effect of estrogen on the cardiovascular system. N Engl J Med. 1999;340(23):180-91.
Pais P, Pogue J, Gerstein H, Zachariah E, Savitha D, Jayaprakash S, et al. Risk factor for acute myocardial infarction in Indians: a case control study. Lancet. 1996;348:358-63.
Rastogi T, Reddy KS, Vaz M, Spiegalman D, Prabhakaran D, Willet WC, et al. Diet and risk of ischaemic heart disease in India. Am J Clin Nutr. 2004;79:582-92.
Joshi PP, Islam S, Pais P, Reddy KS, Prabhakaran D, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297:286-94.
Gupta R, Gupta VP, Ahluvalia NS. Educational status, coronary heart disease and coronary risk factor prevalence in a rural population of India. BMJ. 1994;309:1332-6.
Rajeev Gupta, KD Gupta. Coronary heart disease in low socio economic status subjects in India, “an evolving epidemic”. Indian Heart J. 2009 Jul-Aug;61(4):358-67.
Brown CD, Higgins M, Donato KA, Rohde FC, garrison R, Obarzanek E, et al. Body mass index and the prevalence of hypertension and dyslipidaemia. Obes Res. 2000;8(9):605-19.
Gan SK, Loh CY, Seet B. Hypertension in young adults- an under estimated problem. Singapore Med J. 2003;44(9):448-52.
Sonne-Holm S, Sorensen TI, Jensen G, Schnohr P. Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men. BMJ. 1989;299(6702):767-70.
Thompson D, Edelsberg J, Colditz GA, Bird AP, Oster G. Life time health and economic consequences of obesity. Arch Intern Med. 1999;159(18):2177-83.
Sreedharan J, Mathew E, Muttappallymyalil J, Sharbati SA, Shaikh RB, Basha SA. Determinants of blood pressure among youth in Ajman, UAE. Natl J Epidemiol. 2010;1(1):17-21.
Berenson GS, Srinivasan SR, Bao W, Newman WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa heart study. N Engl Med. 1998;338(23):1650-6.
Davy KP, Hail JE. Obesity and hypertension: two epidemics or one? Am J Physiol Regul Integr Comp Physiol. 2004;286(5):R803-13.
Jannuzzi A, Licenziati MR, Acampora C, Renis M, Agrusta M, Romano L, et al. Carotid artery stiffness in obese children with metabolic syndrome. Am J Cardiol. 2006;97(4):528-31.
Stelfox HT, Ahmed SB, Ribeiro RA, Gettings EM, Pomerantsev E, SCHmidt U. Haemodynamic monitoring in obese patients: the impact of body mass index on cardiac output and stroke volume. Crit Care Med. 2006;34(4):1243-6.
De Simone G, Devereux RB, Kizer JR, Chinali M, Bella JN, Oberman A, et al. Body composition and fat distribution influenze systemic haemodynamics in the absence of obesity: the hyper GEN study. Am J Clin Nutr. 2005;81(4):757-61.
Shi L, Krupp D, Remes R. Salt fruit and vegetable consumption and blood pressure development: a longitudinal study in healthy children. Br J Nutr. 2014 Feb;111(4):662-71.
Damasceno MM, de Araiyo MF, de Freitas RW, de Alemdia PC, Zandli MI. The association between blood pressure and consumption of fruits, vegetables and fruit juice. An exploratory study. J Clin Nurs. 2011 Jun;20(11-12):553-60.
Galhotra A, Abrol A, Agarwal N, Goel N, Gupta S. Life style related riskfactors for cardiovascular diseases in Indian adolescents. Internet J Health. 2009;9(2):doi: 10.5580/4d4.
Winkelmayer WC, Stampfer MJ, Willet WC, Lurhan GC. Habitual caffeine intake and risk of hypertension in women. JAMA. 2005;294(18):2330-5.
Wolf A, Bray GA, Popkin BM. A short history of beverage and how our body treats them. Obese Rev. 2008;9(2):151-64.
Jayanth K, Notani PN, Gualti SS, Gadre VV. Tobacco usage in school children in Bombay, India. A study of knowledge, attitude and practice. Indian J Cancer. 1991;28:139-47.
