Study of prevalence of prehypertension and hypertension among urban school-going children in Tripura

Aghore Debbarma; Arpita Mohanty; Taranga Reang

doi:10.4103/jopcs.jopcs_29_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 4 | Issue : 1 | Page : 24-27

Study of prevalence of prehypertension and hypertension among urban school-going children in Tripura

Aghore Debbarma¹, Arpita Mohanty², Taranga Reang³
¹ Department of Physiology, Agartala Government Medical College and GBP Hospital, Tripura, India
² Department of ENT, NRS Medical College, Kolkata, West Bengal, India
³ Department of Community Medicine, Agartala Government Medical College and GBP Hospital, Tripura, India

Date of Submission	02-Sep-2022
Date of Decision	02-Nov-2022
Date of Acceptance	27-Nov-2022
Date of Web Publication	10-Jan-2023

Correspondence Address:
Dr. Taranga Reang
Agartala Government Medical College and GBP Hospital, Tripura
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jopcs.jopcs_29_22

Abstract

Introduction: Prehypertension is defined as an independent category of blood pressure (BP) by the seventh joint national committee on prevention, detection, evaluation, and treatments of BP. Systolic BP (SBP) between 120 and 139 mm Hg or diastolic BP between 80 and 89 mm Hg are considered to have prehypertension. BP ≥140/90 mm Hg is considered hypertension. It is to assess the prevalence of prehypertension and hypertension among urban school-going children. Materials and Methods: A cross-sectional study was conducted among 1011 school-going children of both sexes within 12–17 years of age group and each participant was selected using a simple random sampling technique. Pretested predesigned questionnaire was used for data collection. Results: Prevalence of normotensive, prehypertensive, and hypertensive were 73.6%, 19.4%, and 7%, respectively, when both systolic and diastolic components have been taken into account. Conclusion: This study has showed that more than 19% prehypertensive and 7% hypertensive among the school-going children aged between 12 and 17 years when both systolic and diastolic components have been taken into account.

Keywords: Hypertension, prehypertension, school-going children

How to cite this article:
Debbarma A, Mohanty A, Reang T. Study of prevalence of prehypertension and hypertension among urban school-going children in Tripura. J Prim Care Spec 2023;4:24-7

How to cite this URL:
Debbarma A, Mohanty A, Reang T. Study of prevalence of prehypertension and hypertension among urban school-going children in Tripura. J Prim Care Spec [serial online] 2023 [cited 2023 Jun 6];4:24-7. Available from: https://www.jpcsonline.org/text.asp?2023/4/1/24/367484

Introduction

Prehypertension is an American classification for cases where a person's BP is elevated above normal but not to the level considered to be hypertension. Prehypertension is defined as an independent category of BP by the seventh joint national committee on prevention, detection, evaluation, and treatments of BP. The subjects with systolic BP (SBP) between 120 and 139 mm Hg or diastolic BP (DBP) between 80 and 89 mm Hg are considered to have prehypertension. Readings ≥140/90 mm Hg is considered hypertension.^[1]

On the other hand, SBP between 90 and 119 mmHg, and DBP between 60 and 79 mmHg are classified as the normal and desired BP. Classification of BP is based on two or more readings on two or more separate occasions separated by at least 1 week.^[2]

Adolescents comprise approximately one-fifth of the world's population and most of them (85%) live in developing countries.^[3] According to National Family Health Survey – II, India, 1989–1999 mid adolescent boys constitute about 5.2% of the total population and mid-adolescent girls constitute 5.1% of the total population.^[4] There is a definite rise in the prevalence of essential hypertension in children and adolescents across the globe.^[5],[6] Elevated BP s at a young age is a predictor of BP elevation later in life.^[5] According to World Health Report 2002,^[7] cardiovascular diseases (CVDs) will be the largest cause of death and disability by 2020 in India. In 2020 AD, 2.6 million Indians are predicted to die due to coronary artery disease which constitutes 54.1% of all CVD deaths. Nearly half of these deaths are likely to occur in young- and middle-aged individuals (30–69 years).

Prevalence of prehypertension and hypertension was 2.9% and 2.8% in urban children and 2.8% and 2% in rural children of the Mysore district respectively with no statistically significant difference between them.^[8] In a study 3.8% of those with prehypertension, on a follow-up, BP measurement had confirmed hypertension (estimated 0.3% prevalence).^[9] An estimated 30%–60% of the variation in BP between individuals, after adjustment for age and sex, is attributed to the effect of genetic factors. A child with a history of hypertension in both parents, and who has a sibling with hypertension, has a 40%–60% chance of developing hypertension as an adult. The genetic susceptibility to develop primary hypertension results from the effects of multiple genes and is modulated by multiple environmental determinants.^[10]

Sympathovagal imbalance (SVI) was observed to be present in both normotensive and prehypertensive siblings of hypertensive parents. In normotensive siblings, SVI was mild in the form of a proportionate increase in sympathetic and decreased vagal activity. In prehypertensive siblings, SVI was prominent with more of vagal withdrawal.^[11] Overweight and obesity prevalence rates varied by country and were 16.6% in China, 4.1% in India, and 37.1% in Mexico.^[12]

Over the last decades, due to the rise in per capita income, junk food has become a status symbol in many of Indian families due to which concept of food has changed from a means of nourishment to a marker of lifestyle and a source of pleasure.^[13] The BP was positively correlated with age, height, body mass index (BMI), and body surface area.^[14] The major determinants were found to be increased BMI and decreased physical activity.^[15] Prehypertensive individuals are more likely to be overweight and obese, to have other cardiovascular risk factors, to progress to established hypertension, and to experience premature clinical CVD.^[16] the objective of the study is to assess the prevalence of prehypertension and hypertension among urban school-going children in Tripura.

There is insufficient documentation regarding the epidemiological situation and risk factors of childhood prehypertension and hypertension in different states in India. There is a rising trend in the prevalence of prehypertension and hypertension in India in all age groups including the younger population. Studying the prevalence of prehypertension and hypertension in this part of the state, Tripura can give access to their present status and would be useful in avoiding the disease progression.

Materials and Methods

This cross-sectional study was conducted at government schools of Agartala city. Nine government schools of Agartala city were randomly selected. The study was conducted during the year 2014 at randomly selected nine schools in Agartala city. The schools were surveyed and overall 1422 were eligible for the study. However, 1011 school-going children of both sexes within the 12–17 years of age group were sleeted randomly from the nine schools of Agartala city. Willing and consenting students, either selves or their parents, have been considered for the study, and predesigned and pretested questionnaire was used for data collection. Healthy children between 12 and 17 years of age were included. Children with any acute illnesses or chronic diseases were not considered in this study. The age was determined from the birth date of the school registration record. BP data were recorded. BP was measured using a standardized sphygmomanometer with appropriate cuff size covering the middle two third of the arm. The BP was measured with the child in a sitting position, with the arm at the level of the heart, and after a 5 min rest.

Three BP readings were recorded consecutively with at least 15 min intervals and the average of three readings was taken as their BP on this day. This procedure was repeated, to measure the BP, for another day on the same subjects. Finally, the minimum value among the 2 day readings was taken as the BP of the subject. Prehypertension was defined as SBP between 120 and 139 mmHg or DBP between 80 and 89 mmHg. Readings ≥140/90 mm Hg have been taken as hypertension. Statistical analysis was performed by (Epi info version 6.0, CDC, Atlanta, Georgia, USA) and MS office word 2007 and prevalence was calculated. Data so collected from the respective participants, parents and schools were kept confidential and anonymous. Written consent from parents and ascent from students were obtained before conducting the study. Permission was obtained from the head of the school or service managers of the concerned schools before conducting the study. Clearance was obtained from the institutional ethics committee of Agartala Government Medical College and GBP Hospital, Agartala before conducting the study.

Results

A cross-sectional study was conducted among 1011 school-going children of both sexes of Tripura. The study aimed to assess the prevalence of prehypertension and hypertension in children of the age group 12–17 years. Data were recorded and analyzed using SPSS version 15.0. Out of 1011 participants, 27.1% and 31.3% belonged to the 12 and 13 years age group, respectively. More than 65% were male and the remaining was female. Out of 196 prehypertensives, more than 21% have a family history of prehypertension and out of 71 hypertensives, 17% have a family history of hypertension. More than 16% were prehypertensive and 2.5% were hypertensive, considering the systolic component of BP. Almost 18% were prehypertensive and nearly 7% were hypertensive, considering the diastolic component of BP [Table 1]. Out of 662 males, nearly 21% were prehypertensive and 8.45% were hypertensive. While among 349 females 16.33% were prehypertensive and 4.29% were hypertensive. Boys have a higher prevalence of prehypertensive and hypertensive compared to girls. There was a rise in the proportion of prehypertensives and hypertensives with increasing age in both sexes.

Table 1: Demographic profile of respondent (n=1011)

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Majority of the students were normotensive, followed by prehypertensive and hypertensive when both systolic and diastolic components have been taken into account [Figure 1].

Figure 1: Prevalence of normotensive (73.6%), prehypertensive (19.4%) and hypertensive (7%), where both systolic and diastolic components have been taken into account

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Discussion

A cross-sectional study was conducted among 1011 school-going children of both sexes of different schools in Agartala city, Tripura. About 65.5% of the participants were male while 34.4% were females. More than 27% and 31.3% of the participants belonged to the 12 and 13 years age groups respectively. Participants in age groups 14, 15, 16, and 17 years are 15.3%, 9.3%, 5.8%, and 11.2%, respectively. Considering the systolic component of BP 16.1% were prehypertensive and 2.5% are hypertensive, while18.1% prehypertensive and 6.7% are hypertensive considering the diastolic component of BP. In this study, 19.4% were prehypertensive and 7% hypertensive, where both systolic and diastolic components have been taken into account. Our finding of 7% hypertensive among the age group of 12–17 years was comparable with the observation of 21.5% adolescent hypertensive in the identical age group in a cross-sectional survey^[15] among students including government and private schools in Chennai, where no socioeconomic factors were found to be associated. More than 19% prehypertensive and 7% hypertensive in this study was also in parallel with the result of a study^[12] conducted in BP the community interventions for health with 9.4% prehypertensive and 10.1% hypertensive Indian, respectively, and that 10.8% prehypertensive and 9.2% hypertensive found out in a cross-sectional study^[14] of 1087 Gujarati school going children and adolescents. This study showed that the prevalence of prehypertension with 19.4% among the urban school-going children aged between 12 and 17 years, which was observed to be higher than in other parts of the country like Gujrat^[14], while it was 7% for hypertension which was still lower than that of Gujrat^[14] and Chennai^[15] school going children. The prevalence of adolescent hypertension was 21.5%. There was a significant effect on gender, class of study, BMI, waist–hip ratio. The major determinants were found to be increased BMI and decreased physical activity.^[15] Banerjee et al. found that 10.6% and 12.9% were prehypertensive and hypertensive respectively. Inadequate physical activity and a sedentary lifestyle were reported in 62.3% and 22.7%. Father's occupation, family history of hypertension, mental health symptoms, and being overweight had significantly increased odds of developing hypertension.^[17] According to another study^[13] over the last decades, due to the rise in per capita income, junk food has become a status symbol in many of Indian families due to which concept of food has changed from a means of nourishment to a marker of lifestyle and a source of pleasure. It was found that about 96% of participants consumed junk food while only 4% did not consume junk food followed by multiple junk food observed in 43.9%. The increasing trend in the prevalence of prehypertension in this study might have been related to food habit and obesity.

A study^[18] in Karnataka showed that the prevalence of systolic prehypertension among urban school-going children was 5.1% among overweight and 16.6% in the obese group in contrast to that of normal BMI with 0.6% prevalence. Their observation also suggested that the prevalence is higher among urban than rural school-going children. A study in Maharashtra reported that the prevalence of hypertension was 6.48%. Hypertension in males was 6.74% and in females was 6.13%. Prevalence of obesity in hypertension was 8.7% against normotensive 1.1%. Prevalence of hypertension in family members of hypertensive was 18.6% and in normotensive 13.1%. Prevalence of diabetes mellitus in family members of hypertensive was 23.4% and 13.7% in normotensive while prevalence of ischemic heart disease in family members was 12.34% in hypertensive and 8.3% in normotensive.^[19]

A study in Chennai showed that 46.1% were males and 53.9% were females. Overall prevalence of prehypertension and hypertension was 14.2% and 5.5%, respectively. Gender, overweight/obese, junk food intake for >3 days/week, physical inactivity for <3 days/week and parent's history were significant determinants in the development of prehypertension and hypertension.^[20]

A study in Gujarat found that prehypertension was detected in 6.9% and 6.5% and hypertension was found in 6.8% and 7.0% of boys and girls, respectively. Height and weight were found to be a significant predictor of systolic and DBP among both boys and girls.^[21]

A study in Cameroon found that the prevalence of hypertension was higher in urban 12% than semi-urban areas 8.6%. The associated factors were age >14 years and secondary level of education in urban areas; family history of hypertension in semi-urban areas.^[22]

Limitation of the study

The survey was confined to one district of the state with the inclusion of the limited number of schools and students.

Conclusion

This study has shown that the prevalence of 19.4% prehypertensive and 7% hypertensive among urban school-going children aged between 12 and 17 years where both systolic and diastolic components have been taken into account. Further study is recommended involving more students and covering schools of all districts of the state.

Ethical approval

Ethics clearance was obtained from the institutional ethics committee before conducting the study.

Acknowledgment

We thank the ICMR for supporting this study. We also thank the school children and their parents who have given consent for this study. We also thank the teachers for giving the opportunity to carry out this study.

Financial support and sponsorship

ICMR, STS, Reference ID: 2014-00575.

Conflicts of interest

There are no conflicts of interest.

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