Prevalence and correlates of sustained hypertension in adolescents of rural Wardha, central India

Prevalence and Associated Factors of Hypertension Among Adolescents in a Rural Community of North India

BACKGROUND AND AIM

Hypertension exerts a substantial burden on the healthcare system in India. Recent literature suggests hypertension to be a rising health problem not only in adults but also in adolescents. The early diagnosis of hypertension in adolescents and timely interventions are key in reducing the burden of hypertension-related morbidity and mortality in later life. This study aimed to estimate the prevalence and factors associated with hypertension among adolescents residing in a rural community in north India.

MATERIALS AND METHODS

This was a community-based cross-sectional study done in Ballabgarh, Haryana. A computer-generated random sample of 600 adolescents was drawn through a sampling frame of adolescents (10-19 years) listed in the Health Management Information System. House visits were made and a semi-structured interview schedule was used. Blood pressure was measured using a digital blood pressure (BP) apparatus (OMRON digital BP monitor, three readings) with age-appropriate cuffs, and hypertension was defined using the American Academy of Pediatrics 2017/Indian Academy of Pediatrics 2022 criteria. Age-adjusted BMI was calculated using AnthroPlus software (Geneva, Switzerland: WHO). The prevalence of hypertension was reported with a 95% confidence interval. Bivariate and multivariate logistic regression was done to determine the association of hypertension with the associated factors.

RESULTS

In this study, 550 adolescents participated, of which 284 (51.6%) were males. The overall prevalence of hypertension was 18.9% (95% CI: 15.8-22.4%), stage 1 hypertension 17.3% (95% CI: 14.3-20.7%), and stage 2 hypertension 1.6% (95% CI: 0.8-3.1%). The participants aged 15-19 years (adjusted OR: 2.40, 95% CI: 1.51-3.80) compared to adolescents aged 10-14 years, and those who were overweight/obese (adjusted OR: 3.93, 95% CI: 2.14-7.20) compared to those with normal weight had significantly greater odds; whereas the female sex had lesser odds (adjusted OR: 0.49, 95% CI: 0.32-0.81) of having hypertension compared to male adolescents.

CONCLUSION

Approximately one-fifth of the participants in this study had hypertension, highlighting the need for interventions including lifestyle modification and active case finding targeting adolescents.

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial

BACKGROUND

Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs.

OBJECTIVE

This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years.

METHODS

The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level.

RESULTS

We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025.

CONCLUSIONS

This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention.

TRIAL REGISTRATION

Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42450.

Prevalence and subtypes of hypertension in normal-weight and obese Indian adolescents: a cross-sectional study

This cross-sectional study examined the prevalence, stages, subtypes of hypertension, and the associated risk factors in adolescent school children in Western India. We screened 2,644 adolescents, from 10 different private and government schools in urban and rural areas for hypertension, as defined by the 2017 Clinical Practice Guidelines. The association of stages and subtypes with age, gender, body mass index, type of school, and place of residence was analysed. 197 children (7.5%) had hypertension; 170 (6.4%) had stage I, 27 (1%) had stage II and 76 (2.9%) had elevated blood pressure (EBP). The risk of EBP was higher in children > 15 years of age (p = 0.006). Compared with normal-weight children, obese, and overweight children had a higher risk of hypertension [odds ratio (OR) 9 (5.84, 13.88) and 3.77 (2.59, 5.48) respectively], whereas underweight children had a lower risk [OR 0.39 (0.16, 0.98)]. Normal-weight hypertension was seen in 5.2% and was higher in children from government schools (9.4%). Systolic-diastolic hypertension (SDH) was the most common subtype, seen in 136 (5.1%). SDH was more common in girls, in rural children, and in those with stage II hypertension. Isolated diastolic hypertension, seen in 51 (1.9%), was more common in boys, in urban children, and in those with EBP.

Prevalence of hypertension among adolescents (10-19 years) in India: A systematic review and meta-analysis of cross-sectional studies

BACKGROUND

Despite the well-known short-term and long-term ill effects of elevated blood pressure in children and adolescents, pooled data on its burden among Indian adolescents have not yet been synthesized.

OBJECTIVES

We did a systematic review with meta-analysis to calculate the pooled prevalence of hypertension among adolescents (10-19 years) in India.

METHODS

We searched PubMed, Embase, Cochrane library, Google Scholar and IndMed, and included cross-sectional studies reporting data on hypertension prevalence among 10 to19 years old and published in English language from their inception till 1st March 2020. Modified New castle Ottawa scale was used to assess risk of bias based on research design, recruitment strategy, response rate and reliability of outcome determination. A random effects model was used to estimate pooled prevalence, and heterogeneity was assessed using Cochrane's Q statistic test of heterogeneity and I2 statistic. To explore the heterogeneity, we did a meta-regression, and sub-group analyses based on region, study setting and number of blood pressure readings.

RESULTS

Out of 25 studies (pooled sample of 27,682 participants) six studies were of high, eighteen of moderate, and one was of low quality. The prevalence of hypertension across studies ranged from 2% to 20.5%, with a pooled estimate of 7.6% (95% CI: 6.1 to 9.1%), I2 = 96.6% (p-value <0.001). Sub-group analysis restricted only to the western India demonstrated a smaller heterogeneity (I2 = 18.3%). In univariate model of meta-regression, diagnostic criteria was significantly associated with pooled prevalence (-4.33, 95%CI: -7.532, -1.134).

CONCLUSION

The pooled prevalence of hypertension among adolescent in India is 7.6% with substantial heterogeneity between the studies. To tackle the high prevalence of hypertension among adolescents, early detection by screening under school health programme and opportunistic screening at Paediatric OPD should be implemented by Policy makers.

The prevalence and predictors of pre-hypertension and hypertension in Kherameh cohort study: a population based study on 10,663 persons in south of Iran

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) mortality and morbidity among Iranians. The present study aimed to estimate the prevalence of pre-HTN and HTN and some of its related factors in south of Iran. This cross-sectional survey was conducted on the data of the Persian cohort study in Kherameh. The participants consisted of 10,663 people aged 40-70 years. HTN was defined as either systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mmHg or taking medications. Pre-HTN was defined as SBP = 120-139 mmHg and/or DBP = 80-89 mmHg. The logistic regression method was used to identify the factors associated with pre-HTN and HTN. The age-standardized prevalence rate (ASPR) of pre-HTN was 19.66% (95% CI: 19.45-19.86%) and 18.59% (95% CI: 18.36-18.83%) in males and females, respectively. Also, the ASPR of HTN was 21.44 (95% CI: 21.22-21.65%) in males and 33.53% (95% CI: 33.22-33.85%) in females. Male gender, old age, being unemployed, low education level, high body mass index (BMI), no smoking, diabetes, cerebro-cardiovascular disease, suffering from another chronic disease, family history of CVD, and negative family history of cancer and other chronic diseases were independently associated with pre-HTN (p < 0.05). All variables, except for gender, smoking, and family history of cancer, were significantly associated with HTN. Drug abuse was also correlated to HTN (p < 0.05). This study revealed the increased prevalence of HTN in rural and urban areas. Therefore, the health system needs to develop strategies to raise the accessibility of screening and diagnostic services.

Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors

Background

Whilst the burden of non-communicable diseases is increasing in developing countries, little data is available on blood pressure among Tanzanian children. This study aimed at determining the blood pressure profiles and risk factors associated with elevated blood pressure among primary school children in Dar es Salaam, Tanzania.

Methods

We conducted a cross sectional survey among 446 children aged 6–17 years from 9 randomly selected primary schools in Dar es Salaam. We measured blood pressure using a standardized digital blood pressure measuring machine (Omron Digital HEM-907, Tokyo, Japan). We used an average of the three blood pressure readings for analysis. Elevated blood pressure was defined as average systolic or diastolic blood pressure ≥ 90th percentile for age, gender and height.

Results

The proportion of children with elevated blood pressure was 15.2% (pre-hypertension 4.4% and hypertension 10.8%). No significant gender differences were observed in the prevalence of elevated BP. Increasing age and overweight/obese children were significantly associated with elevated BP (p = 0.0029 and p < 0.0001) respectively. Similar associations were observed for age and overweight/obesity with hypertension. (p = 0.0506 and p < 0.0001) respectively. In multivariate analysis, age above 10 years (adjusted RR = 3.63, 95% CI = 1.03–7.82) was significantly and independently associated with elevated BP in this population of school age children.

Conclusions

We observed a higher proportion of elevated BP in this population of school age children. Older age and overweight/obesity were associated with elevated BP. Assessment of BP and BMI should be incorporated in school health program in Tanzania to identify those at risk so that appropriate interventions can be instituted before development of associated complications.

BMI is a Better Indicator of Cardiac Risk Factors, as against Elevated Blood Pressure in Apparently Healthy Female Adolescents and Young Adult Students: Results From a Cross-Sectional Study in Tripura

BACKGROUND

Anthropometric measures are used as indicators of elevated blood pressure, but reported to have variable sensitivity among populations. This study was undertaken to identify the better indicator of Cardiac-risk factors by statistical comparison of BMI, Waist circumference, and Waist to Height (WtHr) ratio in apparently healthy adolescents and young adult female students of Tripura.

MATERIALS AND METHODS

A cross-sectional study was conducted in a resource limited setup on 210 apparently healthy female adolescents and young adult students in Tripura. Mean (±SD) of all parameters were compared (ANOVA) to recognize significant independent (anthropometric measures) and dependent factors (blood pressure indices and so on). Correlation (r) analysis was used to identify the better (p) indicator of blood pressure indices (dependent variable) and its impact was assessed by Multiple Regression analysis.

RESULTS

blood pressure indices are comparatively higher in obese and overweight participants with statistically significant (95.5% confidence) mean differences. Significant correlation with dependent factors is observed with BMI followed by WtHr and Waist Circumference. Impact of anthropometric measures with blood pressure Indices is most significant for BMI (P ≤ 0.020) followed by WtHr (P ≤ 0.500) and waist circumference (P ≤ 0.520).

CONCLUSION

BMI is a superior indicator of blood pressure indices and can identify participants at risk even in apparently healthy adolescent and young adult females.

Occupational Disparities in the Association between Self-Reported Salt-Eating Habit and Hypertension in Older Adults in Xiamen, China

Blood pressure responses to sodium intake are heterogeneous among populations. Few studies have assessed occupational disparities in the association between sodium intake and hypertension in older people. We used cross-sectional data from 14,292 participants aged 60 years or older in Xiamen, China, in 2013. Self-reported salt-eating habit was examined with three levels: low, medium, and high. The main lifetime occupation was classified into indoor laborer and outdoor laborer. Multivariable logistic regression was used to examine associations of hypertension with self-reported salt-eating habit, main lifetime occupation, and their interactions by adjusting for some covariates, with further stratification by sex. Overall, 13,738 participants had complete data, of whom 30.22% had hypertension. The prevalence of hypertension was 31.57%, 28.63%, and 31.97% in participants who reported to have low, medium, and high salt-eating habit, respectively. Outdoor laborers presented significantly lower prevalence of hypertension than indoor laborers (26.04% vs. 34.26%, p < 0.001). Indoor laborers with high salt-eating habit had the greatest odds of hypertension (OR = 1.32, 95% CI [1.09–1.59]). An increased trend of odds in eating habit as salt-heavier was presented in indoor laborers (p-trend = 0.048), especially for women (p-trend = 0.001). No clear trend presented in men. Conclusively, sex-specific occupational disparities exist in the association between self-reported salt-eating habit and hypertension in older individuals. Overlooking the potential moderating role of sex and occupation might affect the relationship between sodium intake and hypertension.

Correlation between hypertension and hyperglycemia among young adults in India

AIM

To assess the correlation between blood pressure levels and fasting plasma glucose levels among young adults attending Chatrapati Shahuji Maharaj University, Kanpur, India.

METHODS

The present study was cross-sectional in nature, conducted among students in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. Study subjects included 185 young adults. Among them, 94 were males and 91 were females, in the age group 17 to 19 years.

RESULTS

Mean age among males was 18.5 ± 1.5 years and among females was 17.9 ± 1.8 years. Of the total 185 study subjects, 61 (32.9%) were classified as pre-diabetic and 20 (10.8%) as pre-hypertensive. Mean waist circumference, systolic blood pressure and serum high density lipoprotein did not vary significantly between normoglycemic and pre-diabetic subjects. However, the mean diastolic blood pressure of pre-diabetics (82 ± 5 mmHg) was significantly higher than normoglycemics (79 ± 6 mmHg). Mean serum cholesterol, serum triglycerides, serum low density lipoprotein (LDL) and serum very low density lipoprotein was also higher among pre-diabetic subjects in comparison to normoglycemic subjects and the difference was statistically significant. Upon multiple linear regression analysis, it was observed that body mass index (BMI) (β = 0.149), diastolic blood pressure (β = 0.375) and serum LDL (β = 0.483) were significantly associated with fasting plasma glucose. Multiple linear regression with diastolic blood pressure as the outcome variable showed that BMI (β = 0.219), fasting blood glucose (β = 0.247) and systolic blood pressure (β = 0.510) were significantly associated.

CONCLUSION

A significant prevalence of pre-diabetes and pre-hypertension in young adults is a matter of concern therefore all young adults need to be targeted for screening of diabetes and hypertension and lifestyle modification.

Blood pressure and its associated factors among primary school children in suburban Selangor, Malaysia: A cross-sectional survey

BACKGROUND

Little is known about the relationship of blood pressure (BP) with adiposity indicators, dietary habits, physical activity, and sleep in school children in Malaysia. We aimed to study about the distribution of BP and its associated factors in primary school children.

MATERIALS AND METHODS

A survey was carried out on a random sample of 335 children in five primary schools. BP was measured with a mercury sphygmomanometer. Anthropometry was done by standard methods. Demographic information, dietary habits, physical activity, and duration of sleep were collected by interviews. World Health Organization classification based on body mass index (BMI) and waist circumference (WC) cut-offs were used to define overweight/obesity. Elevated BP was defined according to US reference standards.

RESULTS

A total 335 children (144 boys and 191 girls) were examined. Their mean age was 9.18 years (standard deviation [SD] = 0.28). Overall mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) were 99.32 mmHg (SD = 10.79) and 67.11 mmHg (SD = 10.76), respectively. Mean BMI and WC were 16.39 (SD = 3.58) and 57.77 cm (SD = 8.98), respectively. The prevalence of pre-hypertension was 12.23% (95% confidence intervals [CIs] 8.73, 15.75) and hypertension was 13.4% (95% CIs 9.78, 17.09). Mean SBP and DBP was higher among overweight and obese children than normal children. By multivariate linear regression analyses, BMI (β = 0.250, P = 0.049) and WC (β = 0.308, P = 0.015) were positively associated with SBP; age (β = 0.111, P = 0.017), BMI (β = 0.320, P = 0.012) were positively associated with DBP but total (weekly) hours of sleep (β = -0.095, P = 0.037) was negatively associated with DBP.

CONCLUSION

BP was associated with BMI and WC. Health promotion activities should be initiated in primary schools.