Prevalence of Hypertension and Its Associated Factors among Indonesian Adolescents

Self-care behavior among adult patients with hypertension in Padang, West Sumatra, Indonesia: A cross-sectional study

Background

Self-care behavior is crucial in preventing chronic diseases, such as hypertension, which has become highly prevalent in Indonesia. Hypertension, often referred to as the "silent killer" due to its asymptomatic nature, can easily go unnoticed. Neglecting its treatment can lead to severe complications, including heart disease, heart failure, and stroke. Despite adults with hypertension feeling well, embracing self-care behavior, including making healthy lifestyle choices, disease management, and enhancing life quality, remains essential.

Objective

This study aimed to describe the self-care behavior of adult patients with hypertension in Indonesia.

Methods

A cross-sectional study design was employed, involving 270 participants selected through consecutive sampling. Data were collected between 15 March and 4 April 2023, using the Hypertension Blood Pressure Self Care Profile (HBP-SCP) questionnaire in six public healthcare centers in Padang City, West Sumatra, Indonesia. The data were analyzed using descriptive analysis, Mann-Whitney, and Kruskal-Wallis tests.

Results

The self-care behavior among adult patients with hypertension was at a moderate level (Mean = 49.78, SD = 6.64), and it had significant differences according to ethnicity (p = 0.041), marital status (p = 0.017), and body mass index (p = 0.008).

Conclusion

The findings highlight the influence of diverse ethnic backgrounds, various marital statuses, and differing body mass index levels, which may lead to distinct approaches to managing hypertension. These results offer valuable insights for nurses and other healthcare professionals to develop comprehensive strategies to enhance self-care among adult patients with hypertension.

Explaining the increase of incidence and mortality from cardiovascular disease in Indonesia: A global burden of disease study analysis (2000-2019)

BACKGROUND

In the last two decades, there has been a discernible shift in the distribution of mortality attributed to cardiovascular disease (CVD) between developing and developed nations; in developed nations, the percentage of deaths caused by CVD decreased from 48% in 1990 to 43% in 2010, while in developing nations, they increased from 18% to 25%. In Indonesia, CVD death has increased substantially and remained elevated in the last ten years. Current behavioral and metabolic risk factors, including hyperglycemia, obesity, dyslipidemia, hypertension, and smoking, enhance the risk of CVD mortality, according to several studies.

AIMS

We undertook a study to determine whether the increase in mortality and incidence of CVD can be attributed to changes in the most common metabolic and behavioral risk factors from 2000 to 2019 across 34 Indonesian provinces.

MATERIALS AND METHODS

Data from 34 province for CVD incidence and mortality and data on changes in metabolic and behavioural risk factors between 2000 and 2019 in Indonesia were obtained from the Global Burden study (GBD) by The Institute of Health Metrics and Evaluation (IHME). A statistical model was applied to calculate the fatalities attributable to the risk factors change using Population attributable fractions (PAF) and baseline year death numbers. Furthermore, we ran multivariate regressions on Summary Exposure Value of risk factors associated with the increasing mortality, incidence rates in a lag year analysis. R software used to measure heteroscedasticity-consistent standard errors with coeftest and coefci. Covariates were added to adjusted models, including the Socio-demographic Index, Primary health care facilities coverage, and GDP per capita.

RESULTS

The age-standardized mortality rate for CVD from 2000 to 2019 in Indonesia, increased from 356.05 to 412.46 deaths per 100,000 population among men and decreased from 357.52 to 354.07 deaths per 100,000 population among women, resulting in an increase of 270.928 per 100,0000 inhabitants of CVD deaths. In the same period, there was an increase in exposure to risk factors such as obesity by +9%, smoking by +1%, dyslipidemia by +1.3%, hyperglycemia by +2%, and hypertension by +1.2%. During this time span, an additional 14,517 men and 17,917 women died from CVD, which was attributable to higher obesity exposure. We apply multivariate regression with province-fixed and year-fixed analysis and find strong correlation between hyperglycemia in women (6; 95%CI 0 to 12, death per 1-point increase in hyperglycemia exposure) with an increasing death rate in ischemic heart disease. We also performed a year lag analysis and discovered a robust association between high low density lipoprotein (LDL) levels in men and women and the growing incidence of ischemic heart disease. The association between a 10-year lag of high LDL and the incidence of ischemic heart disease was five times stronger than that observed for other risk factors, particularly in men (5; 95%CI 2 to 8, incidence per 1-point increase in high LDL exposure).

CONCLUSION

Hyperglycemia in women is an important risk factor associated with increasing mortality due to Ischemic Heart Disease (IHD) in Indonesia This study also revealed that the presence of high LDL in both men and women were associated with an increase incidence of IHD that manifested several years subsequent to exposure to the risk factor. Additionally, the highest cardiovascular death portion were attributed to obesity. These findings suggest that policymakers should control high LDL and hyperglycemia 10 years earlier prior to the occurrence of IHD and employ personalized therapy to regulate associated risks.

Validation and Reliability of Lifestyle Instruments for Indonesian Adolescents with Hypertension Family History: A Rasch Model

BACKGROUND: There are lifestyle changes among adolescents in this modern era, such as less physical activities, because many activities can be carried out using modern technology, unhealthy food habits such as eating junk food, canned food and beverages, and preserved fruits and vegetables, poor sleeping habits, stress, and smoking behavior. These lifestyles are harmful and lead to cardiometabolic diseases such as obesity and hypertension, especially in adolescents with hypertension history in the family. AIM: This study aimed to assess the validation and reliability of healthy lifestyle instruments for Indonesian adolescents with a family history of hypertension. METHODS: This study is a survey research conducted from July 2021 to February 2022 in South Sumatera, Indonesia. The subjects were adolescents with a family history of hypertension and recruited using purposive random sampling. Adolescents aged 10–18 years old who returned signed parental consent forms, gave written assent to participate, and completed the questionnaire were included in the study. The questionnaire was consisted of three sections, Section I contained internal factors, Section II related to external factors, and Section III related to healthy lifestyle. The study was approved by the Research Ethics Committee Universitas Padjadjaran Bandung. Winsteps software was used to analyze the validity, reliability, unidimentionality, and rating scale. RESULTS: Obtained 103 valid question items with OUTFIT values 0.5 < mean square < 1.5; −2.0 < ZSTD < 2.0; and the point measure correlation (Pt Mean Corr) value is in the range of 0.32 < Pt Measure Corr < 0.85. The reliability value of respondents and instruments is 0.88, with a ’Cronbach’s alpha value of 0.95. The raw variance explained by the measured value is 72.3%, and all unexplained variance values are <15%. CONCLUSIONS: Healthy lifestyle instruments are valid and reliable, so it is feasible to measure the healthy lifestyle of Indonesian adolescents with a family history of hypertension. This instrument can measure the success of a program or intervention in changing a lifestyle in adolescents at risk of developing hypertension, especially adolescents with a family history of hypertension. We suggest further research involving more participants in a broader area. We hope the healthy lifestyle instruments can be used in a standardized manner for all regions of Indonesia.

Hypertension as a silent epidemic among late adolescent girls, its associated demographic factors, and pregnancy outcome: A report from national family health survey (NFHS) IV data

Background

Hypertension is predominantly considered to be a disease frequently occurring after the fifth decade of life, its occurrence among adolescents has not received much public health attention. Pathophysiological and epidemiological evidence suggests that essential hypertension initiate in childhood and often goes unnoticed unless explicitly observed for this age group.

Aim

The current study estimates the prevalence of hypertension, its predictors, and pregnancy outcome among late adolescent girls (15-19 years).

Material and Methods

The study used secondary data from the NFHS 4 from January 2015 to December 2016. The sample of 1,24,878 adolescent girls out of 6,99,686, national women's data was obtained through a stratified two-stage sample using a population proportionate to size sampling methodology. Descriptive statistical tests and inferential statistics were performed to find the relation of hypertension with the independent variables and Chi-square analysis to study association of hypertension during pregnancy and its adverse pregnancy outcomes.

Results

The prevalence of hypertension among the late adolescents was 16.4% [CI: 16.2-16.6] (n=20,532). On multivariable logistic regression (after adjusting for all the variables) only age [AOR: 1.09 (1.08-1.11)]; education [AOR: 1.09 (1.006 - 1.2)], and wealth index [AOR: 1.17 (1.11 - 1.24)] retained the significance with hypertension. A significant association was seen between hypertension status of the adolescents and adverse pregnancy outcomes (χ² = 4.550, P = 0.033).

Conclusion

Nearly 1/6^th of late adolescents found to be hypertensive, significantly contribution to disease burden. Also, a significant association is seen between hypertension status of adolescents and adverse pregnancy outcomes. Hence, it is imperative to make the National Programme inclusive for adolescents and have a focused approach to health promotion, prevention, and management of non-communicable diseases.

Deriving Normative Data on 24-Hour Ambulatory Blood Pressure Monitoring for South Asian Children (ASHA): A Clinical Research Protocol

BACKGROUND

The global prevalence of hypertension in children and adolescents has increased over the past 2 decades and is the strongest predictor of adult hypertension. South Asians have an increased prevalence of metabolic syndrome associated risk factors including abdominal obesity, diabetes, and hypertension. All these factors contribute to their increased cardiovascular disease burden. Accurate and early identification of hypertension in South Asian children is a necessary aspect of cardiovascular disease prevention. Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard for pediatric blood pressure (BP) measurement. However, its utilization is limited due to the lack of validated normative reference data in diverse, multiethnic pediatric populations.

OBJECTIVE

The primary objective is to establish normative height-sex and age-sex-specific reference values for 24-h ABPM measurements among South Asian children and adolescents (aged 5-17 years) in Ontario and British Columbia, Canada. Secondary objectives are to evaluate differences in ABPM measurements by body mass index classification, to compare our normative data against pre-existing data from German and Hong Kong cohorts, and to evaluate relationships between habitual movement behaviors, diet quality, and ABPM measurements.

DESIGN

Cross-sectional study, quasi-representative sample.

SETTING

Participants will be recruited from schools, community centers, and places of worship in Southern Ontario (Greater Toronto and Hamilton area, including the Peel Region) and Greater Vancouver, British Columbia.

PARTICIPANTS

We aim to recruit 2113 nonoverweight children (aged 5-17 years) for the primary objective. We aim to recruit an additional 633 overweight or obese children to address the secondary objectives.

MEASUREMENTS

Ambulatory BP monitoring measurements will be obtained using Spacelabs 90217 ABPM devices, which are validated for pediatric use. The ActiGraph GT3X-BT accelerometer, which has also been validated for pediatric use, will be used to obtain movement behavior data.

METHODS

Following recruitment, eligible children will be fitted with 24-h ABPM and physical activity monitors. Body anthropometrics and questionnaire data regarding medical and family history, medications, diet, physical activity, and substance use will be collected. Ambulatory BP monitoring data will be used to develop height-sex- and age-sex-specific normative reference values for South Asian children. Secondary objectives include evaluating differences in ABPM measures between normal weight, overweight and obese children; and comparing our South Asian ABPM data to existing German and Hong Kong data. We will also use compositional data analysis to evaluate associations between a child's habitual movement behaviors and ABPM measures.

LIMITATIONS

Bloodwork will not be performed to facilitate recruitment. A non-South Asian comparator cohort will not be included due to feasibility concerns. Using a convenience sampling approach introduces the potential for selection bias.

CONCLUSIONS

Ambulatory BP monitoring is a valuable tool for the identification and follow-up of pediatric hypertension and overcomes many of the limitations of office-based BP measurement. The development of normative ABPM data specific to South Asian children will increase the accuracy of BP measurement and hypertension identification in this at-risk population, providing an additional strategy for primary prevention of cardiovascular disease.

Comparison of China Reference with Different National and International References: The Prevalence of High Blood Pressure in 695,302 Children and Adolescents in a Metropolis of Yangtze River Delta, China

Objectives

This study aimed to compare performances of China reference and different national references on high blood pressure (HBP).

Methods

A cross-sectional study including 695,302 children and adolescents aged 7 to 17 years in Suzhou, China, was conducted to determine the prevalence of HBP based on U.S., international, Europe, and China references in 2016.

Results

Different percentiles of height and blood pressure were found among four references. Referring to U.S. reference, the prevalence of HBP was the highest with 26.0%, followed by International reference with 20.0%, Europe reference with 19.5%, and China reference with 19.2%. McNemar tests indicated statistically significant differences between HBP prevalence comparing China reference with the other 3 references (P < 0.001). The area under the curve was 0.947, 0.851, and 0.949 for U.S., international, and Europe reference, respectively. U.S. reference showed the highest sensitivity (98.2%), but the lowest specificity (91.2%), and Europe reference showed the highest kappa value (0.893).

Conclusions

The prevalence of HBP varied among these four references, and the appropriate choice of reference would be important to recognize high-risk children and judge the trends of HBP prevalence in the targeted population.

Association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents

Background

Determining high blood pressure in childhood is an important step to reduce the risk of occurrence of high blood pressure-related diseases in adulthood.

Aims

This study aimed to assess the association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents.

Patients and Methods

This cross-sectional study included 370 students (202 females, 168 males) aged 14 to 18 years from one private and one public school in Kayseri, Turkey. Some anthropometric measurements and 24-hour dietary recall of the students were obtained. Their blood pressures were measured, and the International Physical Activity Questionnaire and the Mediterranean Diet Quality Index (KIDMED) were used.

Results

The body mass index (BMI) mean and waist/height ratio of the hypertensive group were significantly higher than those of the prehypertensive group, whereas their daily potassium, calcium, and magnesium intakes were significantly lower than those of the normotensive group. The percentage of individuals with very low diet quality was higher in the hypertensive group than in the normotensive group (P > 0.05). The percentage of participants with sufficient physical activity was higher in the normotensive group than in the prehypertensive and hypertensive groups.

Conclusion

Factors such as high BMI and waist/height rates; low calcium, magnesium, and potassium intakes with diet; insufficient physical activity; and low quality of diet might cause an increase in the blood pressure.