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Prevalence of hypertension among young adults in a Jaipur district of Rajasthan, India

Developing Countries have undergone rapid industrialization, Urbanization, Globalization and economic development over the last four decades. As a consequences, standard of living has improved but with a detrimental shift toward inappropriate dietary patterns and reduction in physical activities. This health transition will ultimately effect the health of young adults with people in reproductive age group of present generation. Prevalence of Hypertension in India ranges from 17% to 29.8%. Cardiovascular diseases are the leading cause of death globally, accounting for approximately 31% of all global deaths. Of these 17.5 million, 7.4 million were due to coronary heart disease and 6.7 million were due to stroke. Increased blood ABSTRACT


Developing
Countries have undergone rapid industrialization, Urbanization, Globalization and economic development over the last four decades. As a consequences, standard of living has improved but with a detrimental shift toward inappropriate dietary patterns and reduction in physical activities. 1 This health transition will ultimately effect the health of young adults with people in reproductive age group of present generation. Prevalence of Hypertension in India ranges from 17% to 29.8%. 2 Cardiovascular diseases are the leading cause of death globally, accounting for approximately 31% of all global deaths. Of these 17.5 million, 7.4 million were due to coronary heart disease and 6.7 million were due to stroke. Increased blood pressure is one of the important risk factors of cardiovascular disease. 3 According to the WHO's World Health Statistics Report 2012, 21% world's adult population has raised blood pressurea condition responsible for half of all deaths from stroke and heart disease. Hypertension contributes to 4.5 percent of the current global disease burden. 4 The prevalence of hypertension among young adults, is on a steady rise. This may be attributed by several factors such as changed lifestyle and education pattern that leads to stress. We have to improve detection rates by screening in school and colleges periodically. 5 Over 80 percent of cardiovascular deaths in developing countries are due to lack of widespread diagnosis and treatment at early stage as compared to developed countries. 6 India as developing countries face a dual burden of communicable and noncommunicable diseases with shifting trend including hypertension, stroke and coronary artery disease. The primary aim of this study was to determine the prevalence of hypertension among college going young adults as per JNC-VII criteria 7 , as there is a lack of data regarding high blood pressure among young adults.

Study area
A cross-sectional study of students of selected degree colleges over the age of 18 years (18-25years) was conducted in the Jaipur district of Rajasthan, North India. A total of 394 students elected to participate and were administered the survey questionnaire at random, of which 390 participated in the study.
Using the above mentioned values a sample size of 384 was obtained. Considering a non-response rate of 10 %, the final sample size was calculated to be 422.

Sampling and data collection
All eligible students in the respective colleges (B tech) were chosen randomly until we met the required sample size. Clearance was obtained from the concerned college authorities following which written informed consent was taken from participants prior to the administration of semi-structured questionnaires. Part of the questionnaire was filled in by the students and the rest by the investigator following the necessary physical examination

Method of measuring blood pressure
Blood Pressure was measured for all eligible students, on the right arm in sitting posture, with subject in a relaxed state. Standardized mercury sphygmomanometer with adult size cuff was used. Two readings of blood pressure were obtained five minutes apart and average of the readings was taken as the final blood pressure reading. Those found to have hypertension were informed about their blood pressure status and were refer to JNU hospital medicine OPD for further management.
Waist circumference was measured to the nearest 0.1 cm at the mid-point between the costal margin and iliaccrest, using a measuring tape, at the end of normal expiration with the subject standing erect in a relaxed position, feet 25-30 cm apart. Hip circumference was measured at the level of greater trochanters (widest portion of the hip) to the nearest 0.1 cm with measuring tape, with the subject standing with the arm by the side and feet together. Waist-Hip ratio was calculated as the ratio of waist circumference over hip circumference. 8

Diagnostic criteria
Hypertension A student was considered hypertensive if he/she had been previously diagnosed and/or on treatment OR if the systolic blood pressure was ≥140 mm of mercury or diastolic blood pressure was ≥90 mm of mercury at the time of measurement (JNC-VII criteria). 7

Obesity
Waist hip ratio of >1 for males and >0.85 for females were designated as Truncal obesity while waist circumferences of ≥94 cm in males and ≥80 cm in females were designated as Central or Abdominal obesity. 9,10

Data analysis
Data was entered and analyzed in R statistical software and Chi-square tests were applied to analyze the relationship between different variables and hypertension.

RESULTS
During the study 394 questionnaires were distributed. Of them, 390 filled up the questionnaire and physically examined. Nearly 70% of the students were between 18 and 19 years and over 95% were under 21 years ( Table  1). The proportion of males (53.3%) and females (46.7%) was comparable. Hypertension was detected in 20 of the 390 students (prevalence=5.1%), of which the majority were newly diagnosed (65%). The prevalence of hypertension among male students (6.7%) was higher as compared to female students (3.29%) Table 2. In addition, 33.85 % of the subjects were found to have blood pressures in the pre-hypertensive range (Figure 1). A higher prevalence was found among students with history of smoking (52.5%) and alcohol intake (32.3%) as compared to prevalence among the remaining students (Table 3).

DISCUSSION
The persistence of raised blood pressure during childhood and adolescent period and its progression into adult hypertension has been observed in the past. High BP measurements at multiple times in adolescent age group are a predictor of adult hypertension. 11 Therefore regular Blood pressure monitoring in young adults is recommended for the early detection and management of hypertension in early stage.
High Prevalence of increased blood pressure was found among the participants in this study. Similarly, high prevalence have been demonstrated in earlier studies in same age group. 12 About 35% of study subjects was found to be pre-hypertensive, illustrating the necessity of monitoring blood pressure in young adults.
Earlier studies have depicted factors associated with development of hypertension in young adults. Among various factors the most important association was found between obesity and hypertension. Obesity indicators (WHR and waist circumference) have been repeatedly proven to possess a significant positive correlation with elevated blood pressure (systolic and diastolic). [13][14][15][16] Relationships between alcohol consumption or smoking and hypertension were not found significant among the participants of our study.

CONCLUSION
High blood pressure has always been a major health hazard among young adults. Most of the cases remain undiagnosed in the initial stages. Pre-hypertensive cases require regular follow-up. Early identification plays important role since it leads to early management of hypertension thereby reducing complications, such as cardiovascular changes and end organ damage later in life. Further studies need to be conducted as there is lack of data on hypertension in the young adult population in order to formulate right preventive strategies at right time.