Why Is It Valuable to Know if You Are Prehypertensive
J Clin Diagn Res. 2016 Sep; 10(ix): CC05–CC08.
Prehypertension and Its Determinants in Obviously Salubrious Young Adults
Sunandha Senthil
1 Pupil, Kasturba Medical College, Manipal University, Mangalore, Karnataka, Bharat.
Subbalakshmi Narasajjana Krishnadasa
2 Associate Professor, Department of Physiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, Republic of india.
Received 2016 Apr 9; Revisions requested 2016 May 25; Accustomed 2016 Jul 7.
Abstract
Introduction
High incidence of prehypertension is reported in medical undergraduates. Prehypertension may progress to hypertension and eventually cardiovascular disease, a leading cause of morbidity and mortality. Therefore, identifying the chance factors of hypertension in prehypertensive country may assist in effective control of blood force per unit area.
Aim
To discover whether clustering of known gamble factors of hypertension or sure private risk factors alone impact blood pressure in young adults.
Materials and Methods
This was a cross-sectional study washed in 84 apparently salubrious medical students of either sex aged between 18-23 years. It included students with at least one known risk factor of hypertension. Claret pressure levels of 120 to 139/80 to 89 mm Hg were divers every bit prehypertension. The hazard factors considered were male gender, family unit history of cardiovascular disease, sedentary life, full general and cardinal obesity, sleep quality, perceived stress and dietary blueprint. Clustering of risk factors was assessed based on collective scoring system in which each risk gene was scored appropriately. Statistical analysis was done by unpaired t, Chi-square and Pearson correlation coefficient tests. The p<0.05 was considered significant.
Results
There was a positive correlation between total risk factor score and systolic blood force per unit area (r = 0.266, p = 0.015). Among the take a chance factors, frequency of males with systolic and diastolic prehypertension was higher compared to females (p <0.0001,= 0.022 respectively). Body mass index was college in systolic and diastolic prehypertensives compared to normotensives (p <0.001, 0.002, respectively). Waist circumference was higher in systolic and diastolic prehypertensives compared to normotensives (p< 0.0001).
Conclusion
In obviously healthy immature adults, male gender and obesity are the major risk factors of elevated blood pressure.
Keywords: Body mass index, Male gender, Medical undergraduates, Waist circumference
Introduction
Medical undergraduate students, evolving from adolescence to adulthood, are faced with academic and clinical challenges every twenty-four hours. This might lead to change in life fashion and thereby brand them susceptible to hypertension. Supporting this, our own study on medical students and many other studies have reported loftier incidence of pre-hypertension in medical students [1–3]. Prehypertension is an early indicator of clinical hypertension and later of the Cardiovascular Diseases (CVD) [4]. CVD is the major crusade of death worldwide [five].
Thus, the 7th Report of the Articulation National Committee on Prevention, Detection, Evaluation, and Treatment of High Claret Pressure (BP) defined BP levels of 120 to 139/80 to 89 mm Hg equally prehypertension based on the evidence of a small increase in cardiovascular take a chance among individuals with such levels [iv].
Obesity [6], stress [7], unhealthy nutrition [eight], family history of CVD [9], male person gender [6] and sleep impecuniousness [ten] are some of the chance factors of hypertension. Weight losses through structured exercise programme [11], vegetarian diet [viii] are reported to lower BP. Hence, in that location tin be interplay of BP elevating and lowering factors in determining prevailing BP in an private. However, male gender and family history of CVD are non- modifiable take a chance factors.
Accordingly, information technology could be hypothesized that in many individuals, commonage effect of risk factors and extent of modifiable risk factors may determine BP; merely in certain individuals, a non -modifiable risk factor alone may impact BP adversely in-spite of BP lowering programmes.
Currently, lacunae persist in establishing whether hypertension manifests owing to sole non-modifiable risk gene or while several risk factors cluster. Therefore this pilot study was undertaken. This study model incorporated a scoring system in which each take chances cistron was assigned a score and summed up for every individual. Clan between summed-up score and BP was assessed. As well, to ascertain if whatever single dominant factor determines prehypertension, each characteristic of prehypertensives was compared with normotensives. The same population was also studied to evaluate the relation between Hb and pre-hypertension.
Materials and Methods
This was a cross-sectional written report done in 84 patently salubrious undergraduate medical students. Study included both males and females aged between 18-23 years and pursuing MBBS in a medical college in Mangaluru, Karnataka, Republic of india. This study was done after obtaining the Institutional Ethics Committee blessing and informed consent from the study participants. This study of one month elapsing during June 2014 (Past assuming 0.5 correlation, with 95% conviction level and 90% power, a total of 75 subjects were to be selected. Yet, the study included 84 participants).
Inclusion criteria: Students with at least one known risk factor and consenting to participate were only included in the study.
Exclusion criteria: Students who were chronic smokers, alcoholic and known cases of diabetes, dyslipidemia or on whatever medication known to touch BP were excluded.
Study protocol
All the study procedures were carried out betwixt four-6 pm in all the study subjects. Prehypertension was divers as BP levels of 120 to 139/eighty to 89 mm Hg [4]. General obesity was considered if the BMI > 23.33 kg/m2. For abdominal obesity 2 cutting offs were considered: Level i -if the waist circumference (WC) was 78cm or more for males; 72cm or more for females. Level two-if the WC was xc cm or more for males and 80 cm or more for females [12]. Sleep quality was assessed every bit per the guidelines provided. The Pittsburgh Slumber Quality Index' by Buysse DJ et al., [13]. Perceived stress was defined as per the guidelines described in 'Perceived Stress Scale' by Sheldon Cohen [14]. The diet blueprint was assessed by a questionnaire based on Dietetics [xv]. Severity of risk factors was assessed based on commonage scoring system (method followed is described subsequently).
Personal interview: The basic details of the participants (name, historic period, sex), details regarding the family unit history of CVD and physical action were taken. They were asked to fill the required questionnaire on sleep design [13,16], perceived stress [17] and nutritional status [xv].
Estimation of BMI: Height was estimated by making the field of study lean confronting the wall, standing directly, barefoot and marker with a pencil; the distance between the pencil marker and flat ground was measured using a standard measuring record in cm. Weight was measured using a weighing auto (in kg) while the discipline stood on it barefoot and directly. BMI was calculated every bit weight in kg divided by square of height in meters.
Measurement of waist circumference: At the level of the belly button in expiratory position with a standard measuring tape.
Measurement of BP: Both SBP and DBP was measured in the right arm in the sitting position with the assist of digital BP machine.
Collective scoring of chance factors: Since a study tool to assess adventure factors is available only for CVD [18] merely not for hypertension, each parameter was assigned a score considering the occurrence and severity as presented in [Tabular array/Fig-1].
[Tabular array/Fig-one]:
Pattern of scoring of adventure factor for hypertension.
| Parameters | Description | Scores allotted | |
|---|---|---|---|
| Gender | Female person | 0 | |
| Male | 1 | ||
| Family unit history of CVD | Without | 0 | |
| With | 1 | ||
| Body Mass Alphabetize (kg/thousand2) | < 23 | 0 | |
| 23-24.nine | 1 | ||
| 25 or >25 | two | ||
| Waist Circumference (cm) | Males | Below 78 | 0 |
| 78–89 | 1 | ||
| 90 or more | 2 | ||
| Females | Below 72 | 0 | |
| 72–79 | ane | ||
| eighty or higher up | two | ||
| Diet questionnaire score | xiv | 0 | |
| 15–28 | 1 | ||
| 29–42 | 2 | ||
| 43–56 | 3 | ||
| Sedentary life/Exercise | Taking role in structured exercise programme- sports / yoga/brisk walk regularly at to the lowest degree from the past one year | 0 | |
| Sedentary life | 1 | ||
| Pittsburg Sleep Quality Index (PSQI) | <three | 0 | |
| betwixt 3 to five | 1 | ||
| > 5 | ii | ||
| Cohen perceived stress score | <13 | 0 | |
| thirteen–19 | ane | ||
| xx or more | 2 | ||
Statistical Assay
Unpaired t-test was applied to unpaired data of independent observations fabricated in ii separate groups. Whenever the standard deviation between the groups was not comparable non-parametric equivalent, Isle of mann-Whitney 'U' test was practical. Chi-square test was applied when the information were in frequency. Pearson correlation coefficient was applied to mensurate association of continuous variables. The extent or degree of relationship betwixt 2 sets of figures was measured in terms of correlation coefficient (r). The level of significance was measured past two-tailed test. The diverse analyses were performed using SPSS version 15.0. Statistical significance was taken to be a p-value <0.05.
Results
Out of the 94 students who were approached, 87 turned upward for the study. Among them, iii were chronic smokers and hence excluded from the report. The information on baseline characteristics of 84 subjects studied is presented in [Tabular array/Fig-ii]. Continuous variables are presented as mean ± SD. Chiselled values are presented as whole number and in percentage in parenthesis.
[Table/Fig-2]:
Baseline characteristics of study subjects.
| Variables | Mean ± SD |
|---|---|
| Mean age (years) | 19.69 ± 0.878 |
| Male/female ratio | twoscore (48%) /44 (52%) |
| SBP (mm Hg) | 118.20 ±11.89 |
| DBP (mm Hg) | 72.21 ±8.09 |
| Body Mass Index(kg/m2) | 23.12 ±four.44 |
| Waist Circumference(cm) | 83.12 ±12.34 |
| Diet questionnaire score | 32.sixty ±5.88 |
| Pittsburg sleep quality index (PSQI) | four.89 ±ii.74 |
| Cohen perceived stress score (PSS) | 19.98 ±5.69 |
| Haemoglobin (g/dl) | 13.29 ± 6.69 |
| Pulse charge per unit (beats/minute) | 83.85 ±12.18 |
| Respiratory Rate (cycles/minute) | 17.85±3.06 |
This written report subjects were divided into two subgroups, namely prehypertensives and noromotensives based on systolic and diastolic claret pressure level independently according to JNC criteria [4]. Data was analysed of these groups in relation to full chance factor scores and private risk factors of high blood pressure level separately.
Clan Between Full Risk Factor Scores and Blood Pressure
Data collected on chance factors for high blood force per unit area were scored appropriately and added for each individual. The commonage hazard factors scores of blood pressure level of systolic prehypertensive group was significantly higher compared to normotensive group (eight.33±two.29 vs. 7.59±1.90; Mann-Whitney U statistic 655.fifty, p=0.04). In that location was pregnant positive correlation between collective blood pressure risk factors scores and systolic blood pressure (r = 0.26, p = 0.015, [Tabular array/Fig-3]). At that place was no pregnant difference in collective blood pressure risk factor scores of diastolic prehypertensives compared to normotensive group (viii.5± 2.52 vs. 7.79± 1.97; Mann-Whitney U statistic= 472.50, p=0.079). There was no pregnant correlation between collective blood pressure risk factors scores and diastolic claret pressure (r = 0.18, p = 0.098).
Correlation between total risk factor scores and systolic blood pressure in study subjects.
Y= 1.4874x+106.36; r= 0.266; p = 0.015, where y = systolic claret pressure (mmHg) and x = total hazard factor scores.
Comparison of Individual Risk Factors Between Prehypertensive and Normotensive Groups
Information collected on risk factors of hypertension was individually compared betwixt normotensives and prehypertensives (systolic and diastolic prehypertensives with normotensives separately). Among the risk factors, information on gender, family history of CVD and subjects leading sedentary life are presented in frequency. Information on BMI, WC, Nutrition sleep quality index and perceived stress score is presented as mean ± SD.
Comparison of Frequency of Male Gender, Subjects with Family History of CVD and Leading Sedentary Life Betwixt Prehypertensives and Normotensives
Frequency of males with systolic prehypertension was significantly college compared to females (n = 28 (seventy%) vs. 14 (31.8%), Chi-square=12.28, p<0.0001). Frequency of male subjects with diastolic prehypertension was significantly higher compared to female subjects (n = xiv (35.0%) vs. northward = 6 (xiii.6%) Chi-square=5.271, p = 0.022). Number of subjects with family history of CVD in systolic pre-hypertensive group was non significantly dissimilar compared to normotensive group (due north = 23 (54.8%) vs. northward = nineteen (45.two%), Chi-foursquare = 0.762, p = 0.383). Number of subjects with family history of CVD in diastolic prehypertensive group was not significantly different compared to normotensive group (n = x (23.viii%) vs. 10 (23.8%). Number of subjects not doing exercise in systolic pre-hypertensive grouping was not significantly unlike compared to normotensive group (northward =24 (57.xiv%) vs. north = thirty (71.42%), Chi-square =1.868, p = 0.172). Number of subjects non doing practise in diastolic prehypertensive group was not significantly different compared to normotensive group (northward = sixteen (29.6%) vs. 4 (13.3%), Chi-square = ii.823, p = 0.09).
Comparison of Individual Risk Factors (continuous variables) Betwixt Prehypertensives and Normotensives
Information on comparison of BMI, waist circumference, PSQI score, diet score and perceived stress score betwixt systolic prehypertensive and normotensive groups are presented as mean ± SD in [Table/Fig-iv] and on diastolic prehypertensives is presented in [Tabular array/Fig-5]. BMI and waist circumference of systolic prehypertensives was significantly higher compared to normotensives (p <0.001, < 0.0001 respectively) [Tabular array/Fig-4].
[Table/Fig-four]:
Comparing of individual risk factors and total take chances factor score between normotensives and systalicprehypertensives (values are hateful± SD)
| Parameters | Systolic Prehypertensives (n =42) | Normotensives (n = 42) | t-value | p-value |
|---|---|---|---|---|
| BMI(kg/m2) | 24.64 ± 4.45 | 21.59 ± iii.ninety | 3.342 | 0.001 |
| WC(cm) | 88.66±12.46 | 77.58± 9.48 | iv.586 | < 0.0001 |
| Diet score | 31.86± 6.nineteen | 33.33± five.51 | 1.153 | 0.252 |
| PSQI | iv.40± 2.77 | 5.38± ii.64 | 1.651 | 0.102 |
| PSS | 19.35± 6.fifty | 20.59± four.74 | 0.997 | 0.322 |
| Total hazard score | 8.33± 2.29 | 7.59± 1.90 | 655.l* | 0.042 |
[Table/Fig-5]:
Comparing of private risk factors and total risk factor score betwixt normotensives and diastolic prehypertensives (values are mean± SD)
| Parameters | Diastolic Prehypertensives (north = xx) | Normotensives (due north = 64) | t | p-value |
|---|---|---|---|---|
| BMI(kg/mtwo) | 25.73 ± four.77 | 22.30 ± 4.04 | iii.169 | 0.002 |
| WC(cm) | 91.3±13.87 | lxxx.57± 10.71 | three.636 | < 0.0001 |
| Nutrition | 30.45± 6.71 | 33.27± 5.48 | i.89 | 0.060 |
| PSQI | iii.40 ± 2.eighteen | five.35 ± 2.73 | ii.918 | 0.005 |
| PSS | xx.50± 6.84 | 19.81± 5.33 | 0.469 | 0.640 |
| Total take chances score | eight.v± 2.52 | 7.79± 1.97 | 472.fifty* | 0.079 |
There was no pregnant departure in PSQI score, diet score, and perceived stress score between systolic prehypertensive group and normotensive groups [Table/Fig-four]. BMI and waist circumference of diastolic prehypertensives was significantly college compared to normotensive group (p = 0.002, < 0.0001). PSQI score was significantly lower in diastolic prehypertensive group compared to normotensive group (p = 0.005) [Table/Fig-5]. Diet score and PSS did non differ significantly between diastolic prehypertensive and normotensive groups [Tabular array/Fig-v].
Comparing of Cardiovascular Hazard Factors in Male person and Female person Prehypertensives with Normotensives
The written report parameters that showed meaning difference between prehypertensive grouping and normotensive grouping alone was further analysed separately in male and female person study subjects.
In males, BMI of prehypertensives was significantly college compared to normotensives (24.01± iii.72 (n =13), 20.61± 3.57 (northward =28), t =two.67, p = 0.01); PSQI score was significantly lower in prehypertensives compared to normotensives (4.07±2.26, 6.five±3.17, t = 2.75, p = 0.009). There was no significant difference in waist circumference between prehypertensives and normotensives (88.89 ± 12.34, 81.79± x.89, t= ane.72, p = 0.09).
In females, BMI and waist circumference was significantly higher in prehypertensives compared to normotensives (mean ± SD = 25.ninety ±5.59 (north = 14), 21.97 ±four.02 (n=xxx), Mann-Whitney U-statistic= 105, p = 0.008; mean ± SD = 88.21± 13.15, 75.9 ±8.47, Mann-Whitney U-statistic = 85.50, p = 0.0018 respectively). There was no pregnant deviation in PSQI score betwixt prehypertensives and normotensives (mean ±SD = 5.07± 3.6, 4.93± ii.xxx 209, Mann-Whitney U-statistic = fifty, p = 0.99)
Word
Loftier incidence of prehypertension is reported in young adults [1–3]. Therefore, this pilot study investigated the influence of known risk factors of hypertension on blood pressure in apparently healthy young adults. We also investigated to find any significant association between collective effects of known risk factors of hypertension on claret pressure level in this student population.
In the present study, there was a significant positive correlation between total risk cistron score and SBP. This finding suggests that the clustering of gamble factors may contribute to the elevation of blood pressure level. Though the full score included several factors, the major contributing factors were male gender, BMI and waist circumference. Thus it appears obesity and male gender are the major risk factors of prehypertension in young apparently salubrious adults. In the present report high BMI was identified every bit a major correspondent to elevated blood pressure, particularly SBP. Probably, DBP which is a part of full peripheral resistance is not influenced to such a smashing extent at an early stage of life.
In our written report, frequency of males with prehypertension was significantly higher compared to females. Eran Israeli et al., have found that mean SBP and DBP is significantly higher in male subjects [19]. P Das et al., have also reported higher BP in the male person gender [20]. Rima Abdul Razzak et al., have found significant difference particularly in SBP between the two genders [21]. Our study finding along with the other study findings suggest that males are at greater risk of hypertension.
In the present study BMI and waist circumference of prehypertensive grouping was significantly higher compared to normotensive group. The BMI is widely used equally a surrogate measure of overall adiposity because of its simplicity and high correlation with percent trunk fat [22]. Adult obesity-measured by relative weight or body mass alphabetize is a strong risk predictor of CVD-diabetes mellitus and mortality from all causes [23]. These observations suggest that concrete activities aiming at weight control should be implemented in medical preparation curriculum also.
Researchers investigating on causes of hypertension have observed that sleep deprivation [24,25], diet pattern [26], and stress [7] as some of the adventure factors of hypertension. However, in our written report nosotros did not observe any supportive evidence. On the other mitt sleep quality assessed by PSQI score was higher in subjects whose diastolic blood pressure was within normal range. Most of these previous studies have investigated clan between these risk factors and hypertension in subjects anile 40 years and above different subjects anile between 18-23 years in this study. Prolonged sleep loss and alterations of sleep quality take been identified equally physiological stressor that impairs encephalon function and causes over activation of stress system, thereby elevating BP [27]. However, repeated blood pressure level elevations and surge of catecholamines during stress, over the years, may cause sustained high blood pressure level [vii]. Thus, we speculate that poor sleep quality and perceived stress of much longer duration may cause quantifiable elevation in blood force per unit area. In young adults probably counter regulatory mechanisms in combating rise in blood force per unit area may be more active compared to older subjects.
This was a pilot study undertaken to discover the clan betwixt known take chances factors of cardiovascular illness and prehyperstensive land in apparently young healthy adults. To the best of our noesis, currently there is no scoring system as such to appraise collective effect of several cardiovascular adventure factors in apparently good for you subjects. Thus the scoring system followed in this written report needs to exist explored further in different sets of population.
This cross-sectional study mainly looked at the influence of cardiovascular risk factors contributing to prehypertensive state. Thus follow-up studies of longer period are required to assess the implication of high systolic blood pressure observed in our immature adults. The systolic blood pressure is a role of the cardiac output, that is, it represents the extent of work done by the heart [28]. Therefore it could be speculated that systolic prehypertensive eye works more normal center and if neglected may eventually pb to heart failure.
Conclusion
Male gender and family history are inherited and cannot be changed, thus used as not-modifiable take chances factors in this report. Whereas other adventure factors such as higher trunk weight, sleep quality, diet design, sedentary life can be altered and are the modifiable risk factors. In the present report, incidence of prehypertension was significantly higher in males compared to female subjects. In both males and female person prehypertensives, BMI (a modifiable risk factor) was higher compared to normotensives. In addition in prehypertensive females, waist circumference was higher compared to female normotensives. Thus it could exist ended that in plain healthy young adults, male gender and obesity are the major risk factors of elevated claret pressure.
Acknowledgments
The authors securely admit Indian Council of Medical Enquiry (ICMR), New Delhi, for funding this projection in the course of Brusque Term Students Research Plan (STS-2014-03928) and are grateful to all the participants who also made this possible.
Notes
Fiscal or Other Competing Interests
None.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071926/
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