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Blood pressure profile and its determinants: A study in adolescent school children

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Nawab Tabassum, MD*; Khan Zulfia, MD†; Khan Iqbal M. MD‡; Ansari Mohammed A. MD§; Abqari Shaad, MD, FNB¶ * Assistant Professor, † Professor and Chairman, ‡ Associate Professor, § Professor, Department of Community Medicine; ¶ Department of Paediatrics, Assistant Professor Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Abstract

done to study the independent determinants.

Introduction: Raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of all deaths worldwide. It is a major risk factor for cardiovascular diseases. Raised Blood pressure among children and adolescents has shown tracking to adulthood.

Results & conclusion: The prevalence of hypertension was found to be 7.1% among the study population. Diastolic prehypertension and hypertension was found in 10.2% and 5.8% of adolescents, respectively. 5.3% of adolescents had systolic prehypertension and 3.2% had systolic hypertension. On stepwise logistic regression analysis, it was found that overweight and obesity increased the odds of hypertension by 2.6 times (OR 2.6, CI: 1.3-5.2) and TV viewing for more than 2 hours per day increased the odds by 6 times (OR 6.0, CI: 1.6-22.2). Screening for raised blood pressure is strongly recommended in all schools.

Objectives: 1) To study the blood pressure profile of school going adolescents of Aligarh. 2) To study the demographic and behavioral determinants of the same. Materials and methods: Design: Crosssectional, school-based. Setting: Two affluent and two non-affluent schools in Aligarh. Sample size: 330 school going adolescents each from the affluent and the non-affluent schools (total-660). Study tools: A predesigned & pretested oral questionnaire to elicit information regarding demographic and behavioral factors, and measurement of weight, height, and blood pressure. Statistical analysis: By SPSS 20, chi square test and logistic regression analysis was

 Key Words • Blood pressure profile • Adolescent • Determinants

Received: 24-09-14; Revised: 17-12-14; Accepted: 18-12-14 Disclosures: This article has not received any funding and has no vested commercial interest Acknowledgements: None

Please send in your letters to the Editor at [email protected]

J. Preventive Cardiology Vol. 4

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Blood pressure profile of adolescents and its determinants

Table 1: Blood pressure (mean ± SD) of study subjects according to age and sex

Male

Age group

Female

N

Systolic

Diastolic

n

Systolic

Diastolic

10-11

41

106.6 ± 10.0

71.4 ± 8.0

44

105.1 ± 7.1

67.3 ± 7.4

>11-12

54

104.9 ± 9.4

71.2 ± 7.5

46

106.7 ± 8.7

67.4 ± 7.2

>12-13

73

108.9 ± 9.5

71.2 ± 7.1

66

106.7 ± 7.8

69.2 ± 7.3

>13-14

90

111.4 ± 8.9

70.4 ± 7.6

63

106.9 ± 9.3

69.8 ± 7.6

>14-15

85

112.8 ± 7.8

70.9 ± 6.6

45

110.4 ± 9.0

70.4 ± 6.3

>15-16 Total

37 380

111.8 ± 7.2 109.8 ± 9.2

70.3 ± 7.3 70.8 ± 7.2

16 280

111.0 ± 11.7 107.3 ± 8.7

70.4 ± 10.3 69.0 ± 7.5

Table 2: Percentages of different forms of hypertension in adolescents with respect to sex and BMI group

Blood pressure group

686

J. Preventive Cardiology Vol. 4

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Feb 2015

BMI Group

Sex

Total n = 660

Male n = 380

Female n = 280

Non-overweight/ non-obese n = 563

Overweight n = 65

Obese n = 32

Hypertension

32 (8.4)

15 (5.4)

31 (5.5%)

7 (10.8)

9 (28.1)

47 (7.1)

Systolic hypertension

13 (3.4)

8 (2.9)

9 (1.6)

5 (7.7)

7 (21.9)

21 (3.2)

Systolic prehypertension

22 (5.8)

13 (4.6)

21 (3.7)

8 (12.3)

6 (18.8)

35 (5.3)

Diastolic hypertension

28 (7.4)

10 (3.6)

27 (4.8)

3 (4.6)

8 (25.0)

38 (5.8)

Diastolic prehypertension

37 (9.7)

30 (10.7)

47 (8.3)

13 (20)

7 (21.9)

67 (10.2)

Significance

p > 0.05

J. Preventive Cardiology Vol. 4

No. 3

p < 0.05

Feb 2015

687

Shaad A, et al

Blood pressure profile of adolescents and its determinants

Table 1: Blood pressure (mean ± SD) of study subjects according to age and sex

Male

Age group

Female

N

Systolic

Diastolic

n

Systolic

Diastolic

10-11

41

106.6 ± 10.0

71.4 ± 8.0

44

105.1 ± 7.1

67.3 ± 7.4

>11-12

54

104.9 ± 9.4

71.2 ± 7.5

46

106.7 ± 8.7

67.4 ± 7.2

>12-13

73

108.9 ± 9.5

71.2 ± 7.1

66

106.7 ± 7.8

69.2 ± 7.3

>13-14

90

111.4 ± 8.9

70.4 ± 7.6

63

106.9 ± 9.3

69.8 ± 7.6

>14-15

85

112.8 ± 7.8

70.9 ± 6.6

45

110.4 ± 9.0

70.4 ± 6.3

>15-16 Total

37 380

111.8 ± 7.2 109.8 ± 9.2

70.3 ± 7.3 70.8 ± 7.2

16 280

111.0 ± 11.7 107.3 ± 8.7

70.4 ± 10.3 69.0 ± 7.5

Table 2: Percentages of different forms of hypertension in adolescents with respect to sex and BMI group

Blood pressure group

686

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

BMI Group

Sex

Total n = 660

Male n = 380

Female n = 280

Non-overweight/ non-obese n = 563

Overweight n = 65

Obese n = 32

Hypertension

32 (8.4)

15 (5.4)

31 (5.5%)

7 (10.8)

9 (28.1)

47 (7.1)

Systolic hypertension

13 (3.4)

8 (2.9)

9 (1.6)

5 (7.7)

7 (21.9)

21 (3.2)

Systolic prehypertension

22 (5.8)

13 (4.6)

21 (3.7)

8 (12.3)

6 (18.8)

35 (5.3)

Diastolic hypertension

28 (7.4)

10 (3.6)

27 (4.8)

3 (4.6)

8 (25.0)

38 (5.8)

Diastolic prehypertension

37 (9.7)

30 (10.7)

47 (8.3)

13 (20)

7 (21.9)

67 (10.2)

Significance

p > 0.05

J. Preventive Cardiology Vol. 4

No. 3

p < 0.05

Feb 2015

687

Shaad A, et al

Table 3: Association between various sociodemographic factors and hypertension

Variable

p value

Hypertension No (n = 613)

Yes (n = 47)

10–13

302 (49.3)

>13–16

311 (50.7)

22 (46.8) X2 = 0.105, 25 (53.2) df = 1, p > 0.05

Table 4: Association between various behavioral factors and hypertension

Variable

Hypertension

P value

No (n = 613)

Yes (n = 47)

Vegetarian

207 (33.8)

Non-Vegetarian

406 (66.2)

21 (44.7) X2 = 2.299, df = 1, p > 0.05 26 (55.3)

Age group Dietary habit

Sex Male

348 (56.8)

Female

265 (43.2)

32 (68.1) X2 = 2.288, 15 (31.9) df = 1, p > 0.05

Type of school Affluent

300 (48.9)

Non-affluent

313 (51.1)

30 (63.8) X2 = 3.871, 17 (36.2) df = 1, p < 0.05

Type of family Nuclear

420 (68.5)

Joint

193 (31.5)

35 (74.5) X2 = 0.722, 12 (25.5) df = 1, p > 0.05

Mother’s education Up to high school 236 (38.5)

Cooking medium used 452 (73.7) Refined oil/ Mustard oil Ghee/Vanaspati 69 (11.3) More than one oil 92 (15.0)

34 (72.3) 2

4 (8.5) 9 (19.1)

X =0.798, df = 2, p > 0.05

Fruit intake < Once a week

130 (21.2)

12 (25.5)

1–2 times a week

147 (24.0)

12 (25.5)

3–4 times a week 103 (16.8)

7 (14.9)

5 times a week 233 (38.0)

16 (34.0)

X2 = 0.701, df = 3, p > 0.05

Fast food intake

18 (38.3)

Blood pressure profile of adolescents and its determinants

difference was not statistically significant. Systolic prehypertension was found to be more among male adolescents than females, but reverse was found in case of diastolic prehypertension. In this study, 9.8% of adolescents were found to be overweight and 4.8% were obese. A statistically significant association (χ2 = 24.872, df = 2, p < 0.05) was found between hypertension and overweight and obesity, as shown in Table 2. Prevalence of both systolic and diastolic prehypertension and hypertension was found to be higher among the overweight and obese adolescents than their non-overweight counterparts. Association between various socio-demographic factors and hypertension has been shown in Table 3. Type of school (proxy of socioeconomic status) was found to have statistically significant association with hypertension. The prevalence of hypertension among adolescents with family history of hypertension in either parent was 10.6% as compared to 6.1% among adolescents with no family history. However, this difference was not statistically significant. Among various behavioral factors studied, TV viewing was found to have a significant association with hypertension (Table 4).

2

108 (17.6)

24 (51.1)

1–2 times a week

272 (44.4)

11 (23.4)

3 times a week 233 (38.0) Physical activity level

5 (10.6)

256 (41.8) Graduate Father’s education Up to high school 131 (21.4) Intermediate

109 (17.8)

9 (19.1)

Graduate Mother’s occupation Housework

373 (60.8)

27 (57.4)

574 (93.6) 39 (6.4)

293 (47.8)

28 (59.6)

Service

153 (25.0)

9 (19.1)

Others Family history of hypertension No In either or both parents In first degree relatives

688

95 (15.5) 72 (11.7)

X2 = 0.213, df = 2, p > 0.05

41 (87.2) X2 = 2.818, 6 (12.8) df = 1, p > 0.05

Working Father’s occupation Business

Professional

X = 2.785, df = 2, p > 0.05

< Once a week

121 (19.7)

Intermediate

4 (8.5)

X2 = 3.304, df = 3, p > 0.05

6 (12.8)

26 (55.3)

135 (22.0)

16 (34.0) X2 = 3.578, df = 2, p > 0.05 5 (10.6)

75 (12.2)

X2 = 3.510, 20 (42.6) df = 2, p > 0.05 23 (48.9)

Low

172 (28.1)

13 (27.7)

Moderate

325 (53.0)

High

116 (18.9)

X2 = 1.306, 22 (46.8) df = 2, p > 0.05 12 (25.5)

Do not watch

143 (23.3)

3 (6.4)

Up to 2 hours/day 397 (64.8)

32 (68.1)

73 (11.9)

12 (25.5)

Up to 6 hours/day 214 (34.9)

14 (29.8)

>2 hours/day Sedentary level

X2 = 12.031, df = 2, p < 0.05

Table 5: Risk factors for high BP using stepwise logistic regression analysis Odds ratio Confidence interval (CI)

P value

Type of school Non-affluent

Reference

Affluent

1.3

_

_

0.7-2.5

0.401

_

_

1.3-5.2

0.006

BMI-group 2

6–10 hours/day

All the factors found to have significant association with hypertension were subjected to stepwise multiple logistic regression analysis. Overweight and obesity and TV viewing for more than 2 hours per day were found to be the independent determinants of hypertension (Table 5).

Variable

TV viewing

>10 hours/day 403 (65.7)

4 (8.5)

X = 2.735, 355 (57.90) 32 (68.1) df = 2, p > 0.05 44 (7.2) 1 (2.1)

Table 2 also shows the blood pressure profile of the study population according to sex and BMI group. Although prevalence of hypertension, both systolic and diastolic, was found to be more among males than females, the

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

Non-overweight / Reference Non-obese Overweight/Obese 2.6 TV viewing Do not watch

Reference

–

–

Up to 2 hours/day

3.3

1.0-11.0

0.056

More than 2 hours/day

6.0

1.6-22.2

0.008

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

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Shaad A, et al

Table 3: Association between various sociodemographic factors and hypertension

Variable

p value

Hypertension No (n = 613)

Yes (n = 47)

10–13

302 (49.3)

>13–16

311 (50.7)

22 (46.8) X2 = 0.105, 25 (53.2) df = 1, p > 0.05

Table 4: Association between various behavioral factors and hypertension

Variable

Hypertension

P value

No (n = 613)

Yes (n = 47)

Vegetarian

207 (33.8)

Non-Vegetarian

406 (66.2)

21 (44.7) X2 = 2.299, df = 1, p > 0.05 26 (55.3)

Age group Dietary habit

Sex Male

348 (56.8)

Female

265 (43.2)

32 (68.1) X2 = 2.288, 15 (31.9) df = 1, p > 0.05

Type of school Affluent

300 (48.9)

Non-affluent

313 (51.1)

30 (63.8) X2 = 3.871, 17 (36.2) df = 1, p < 0.05

Type of family Nuclear

420 (68.5)

Joint

193 (31.5)

35 (74.5) X2 = 0.722, 12 (25.5) df = 1, p > 0.05

Mother’s education Up to high school 236 (38.5)

Cooking medium used 452 (73.7) Refined oil/ Mustard oil Ghee/Vanaspati 69 (11.3) More than one oil 92 (15.0)

34 (72.3) 2

4 (8.5) 9 (19.1)

X =0.798, df = 2, p > 0.05

Fruit intake < Once a week

130 (21.2)

12 (25.5)

1–2 times a week

147 (24.0)

12 (25.5)

3–4 times a week 103 (16.8)

7 (14.9)

5 times a week 233 (38.0)

16 (34.0)

X2 = 0.701, df = 3, p > 0.05

Fast food intake

18 (38.3)

Blood pressure profile of adolescents and its determinants

difference was not statistically significant. Systolic prehypertension was found to be more among male adolescents than females, but reverse was found in case of diastolic prehypertension. In this study, 9.8% of adolescents were found to be overweight and 4.8% were obese. A statistically significant association (χ2 = 24.872, df = 2, p < 0.05) was found between hypertension and overweight and obesity, as shown in Table 2. Prevalence of both systolic and diastolic prehypertension and hypertension was found to be higher among the overweight and obese adolescents than their non-overweight counterparts. Association between various socio-demographic factors and hypertension has been shown in Table 3. Type of school (proxy of socioeconomic status) was found to have statistically significant association with hypertension. The prevalence of hypertension among adolescents with family history of hypertension in either parent was 10.6% as compared to 6.1% among adolescents with no family history. However, this difference was not statistically significant. Among various behavioral factors studied, TV viewing was found to have a significant association with hypertension (Table 4).

2

108 (17.6)

24 (51.1)

1–2 times a week

272 (44.4)

11 (23.4)

3 times a week 233 (38.0) Physical activity level

5 (10.6)

256 (41.8) Graduate Father’s education Up to high school 131 (21.4) Intermediate

109 (17.8)

9 (19.1)

Graduate Mother’s occupation Housework

373 (60.8)

27 (57.4)

574 (93.6) 39 (6.4)

293 (47.8)

28 (59.6)

Service

153 (25.0)

9 (19.1)

Others Family history of hypertension No In either or both parents In first degree relatives

688

95 (15.5) 72 (11.7)

X2 = 0.213, df = 2, p > 0.05

41 (87.2) X2 = 2.818, 6 (12.8) df = 1, p > 0.05

Working Father’s occupation Business

Professional

X = 2.785, df = 2, p > 0.05

< Once a week

121 (19.7)

Intermediate

4 (8.5)

X2 = 3.304, df = 3, p > 0.05

6 (12.8)

26 (55.3)

135 (22.0)

16 (34.0) X2 = 3.578, df = 2, p > 0.05 5 (10.6)

75 (12.2)

X2 = 3.510, 20 (42.6) df = 2, p > 0.05 23 (48.9)

Low

172 (28.1)

13 (27.7)

Moderate

325 (53.0)

High

116 (18.9)

X2 = 1.306, 22 (46.8) df = 2, p > 0.05 12 (25.5)

Do not watch

143 (23.3)

3 (6.4)

Up to 2 hours/day 397 (64.8)

32 (68.1)

73 (11.9)

12 (25.5)

Up to 6 hours/day 214 (34.9)

14 (29.8)

>2 hours/day Sedentary level

X2 = 12.031, df = 2, p < 0.05

Table 5: Risk factors for high BP using stepwise logistic regression analysis Odds ratio Confidence interval (CI)

P value

Type of school Non-affluent

Reference

Affluent

1.3

_

_

0.7-2.5

0.401

_

_

1.3-5.2

0.006

BMI-group 2

6–10 hours/day

All the factors found to have significant association with hypertension were subjected to stepwise multiple logistic regression analysis. Overweight and obesity and TV viewing for more than 2 hours per day were found to be the independent determinants of hypertension (Table 5).

Variable

TV viewing

>10 hours/day 403 (65.7)

4 (8.5)

X = 2.735, 355 (57.90) 32 (68.1) df = 2, p > 0.05 44 (7.2) 1 (2.1)

Table 2 also shows the blood pressure profile of the study population according to sex and BMI group. Although prevalence of hypertension, both systolic and diastolic, was found to be more among males than females, the

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

Non-overweight / Reference Non-obese Overweight/Obese 2.6 TV viewing Do not watch

Reference

–

–

Up to 2 hours/day

3.3

1.0-11.0

0.056

More than 2 hours/day

6.0

1.6-22.2

0.008

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

689

Shaad A, et al

690

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

Blood pressure profile of adolescents and its determinants

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

691

Shaad A, et al

690

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

Blood pressure profile of adolescents and its determinants

J. Preventive Cardiology Vol. 4

No. 3

Feb 2015

691