Assessment of risk factors for hypertension among undergraduate students in a medical college of Himachal Pradesh, India

INTRODUCTION

Hypertension is a commonest cardiovascular disorder and is major cause of premature death worldwide. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension. An estimated 46% of adults with hypertension are unaware that they have the condition.¹ In addition to overweight and obesity, diet, insufficient physical activity, excessive screen time (ST), and sleep disorders are associated with elevated BP in youth. Many people with hypertension do not notice symptoms and may be unaware there is a problem. Symptoms can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. More severe forms may exhibit fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors. If left untreated, hypertension can cause persistent chest pain (also called angina), heart attacks, heart failure, and an irregular heartbeat, which can lead to a sudden death. of risk factors for hypertension at very early age. The Primordial prevention for hypertension is to prevent the development of its risk factors. In India under the National program for prevention and control of non-communicable diseases the active screening for non-communicable diseases is done of all persons above the age of 30 years by using CBAC checklist but there is need to strengthen the program.²

Aim and objectives

So present study was undertaken to assess the risk factors for hypertension among first year MBBS and results of study could reflect the prevalence of risk factors for hypertension among other medical students and persons with similar age group. More over the Cohort of these MBBS students can followed up and if they develop risk factors and hypertension the appropriate primary and secondary prevention measures could be taken.

METHODS

Study type, location, participants and duration

Cross sectional study was conducted at Dr. Radha Krishnan Government Medical College (RKGMC), Hamirpur, Himachal Pradesh for a period of three months rom 1 August to 31 October. MBBS students studying in First Year at RKGMC, Hamirpur were selected as study participants.

Sample size

All students of first year MBBS. Out of all 120 students 115 students participated in study.

Tools of study

Modified structured pretested self-administered questionnaire; WHO stepwise approach to chronic disease risk factor surveillance (STEPS). Weighing Machine, Measuring tape, Digital BP apparatus and steadiometer. Blood Pressure measurement: Blood Pressure measured two times in Right arm.

Anthropometric measurements

Weight was measured by weighing machine having an accuracy of 0.1 kg and Height was measured by Steadiometer having an accuracy 0.1 centimetre. Body mass index was calculated by using formula (weight in Kg, Height in meters square). On the basis of BMI the study participants were classified in different categories as per WHO classification for Asia region. Waist circumference will be measured by Non stretchable measuring tape. A written valid consent was taken from all the 1st Year MBBS students before conducting the study. They were explained about the purpose of study.

Data collection and analysis

Data was collected in hard copies on structured questionnaire. The collected data was entered into Microsoft Excel. After cleaning for entry errors, it was analysed through epi-info version 7.2.6. The qualitative variables were expressed in terms of frequency and percentage. The quantitative variables were expressed in terms of Mean and standard deviation.

RESULTS

A total of 115 students of MBBS first year participated in the study. The mean age of participants was 19.68±1.46 years. Out of total, there were a total of 31.3% (36) boys and 68.7% (79) girls. Out of all, 84.34% (97) were staying at hostel whereas, 15.66% (18) were staying at their parental home. 33.1% (38) had a family history of hypertension.

Out of all the participants, 51.3% (59) had a normal Body Mass Index, 32.17% (37) had low and 16.52% (19) had a BMI more than the normal. The mean diastolic and systolic blood pressure of all the students were 66.43±8.55 and 112.82±11.95 mmHg respectively. Among all the students, 5 (4.35%) had a raised diastolic blood pressure and 29 (25.22%) had raised systolic blood pressure. Overall, 108 (93.9%) students were normotensive, 7 (6.1%) students were pre-hypertensive and none of them was having hypertension.

Among the study participants only 5 students (4.35%) used to consume alcohol and smoke cigarettes. There was not a single participant who consumes substances other than tobacco and alcohol. Out of all participants, 37 (32.17%) were consuming fast food, 52 (45.22%) were consuming junk food and 33 (28.7%) were consuming high salt containing foods at least thrice a week. Among all the participants, 65 (56.52%) used to consume fruits, 92 (80%) consume green vegetables and 12 (10.43%) consume non-vegetarian foods at least thrice a week.

There was a total of 31 (26.96%) students who play an outdoor game, 100 (86.96%) who walk for a minimum of 30 minutes a day and 26 (22.61%) who practice stress relieving activities like yoga/exercises at least three times in a week.

The mean time sitting or reclining per day was 8.77±4.72 hours for all the participants. There was a total of 58 (50.4%) students who were spending more than 8 hours per day in sitting or reclining.

DISCUSSION

The risk factors for hypertension develop in early child hood such as lack of physical exercise, obesity, consumption of fast food and junk food. The primordial prevention can prevent the development of hypertension and its complications. There were a total of 31.3% (36) boys and 68.7% (79) girl. Similar trend was seen over the last five years (Admission year 2017 to 2021) that there were 82% girls out of total seats of different streams of medicine in Kerla.³ Thirty three percent (38) had a family history of hypertension. Family studies have shown that children of two normotensive parents have three percent possibility of developing hypertension where as the possibility is forty five percent in children of two hypertensive parents.⁴ Out of all the participants, 16.52% had a BMI more than the normal. Children in a 2017 review trusted source who lost weight by changing their diet and physical activity patterns, and who received education and counseling, demonstrated a decrease in blood pressur.⁵ Among all the students, 5 (4.35%) had a raised diastolic blood pressure and 29 (25.22%) had raised systolic blood pressure. The study done by Midha T et al shown prevalence of Hypertension of 18.4%.⁶ The one study done by Sharma et al among the school children of Himachal Pradesh also suggest the prevalence of pre hypertension and hypertension among school children is twenty percent.⁷ The obesity is risk factor for hypertension. The relationship between excess adiposity and increased blood pressure is well established, and it is estimated that obesity accounts for 65–78% of cases of primary hypertension.⁸ Among the study participants only 5 students (4.35%) used to consume alcohol and smoke cigarettes. There was not a single participant who consumes substances other than tobacco and alcoholMost of study participants consume fast food and junk food. Higher prevalence of Hypertension among junk food eaters could be due to their higher salt and fat content which make into action various systems of body and consequently leads to raised BP of both types. Abdominal obesity among participants who seldom consumed sweets was less than those who consumed daily.⁹ Thirty three percent used to consume high salt containing foods at least thrice a week. Most of students consume fruits and vegetables less than three days a week. Liu et al showed that fruit intake of 240 g (3 servings/d) decreased the risk of hypertension by 6.0% (RR, 0.94; 96% CI, 0.93-0.96).¹⁰

Currently seventy three percent students who play an outdoor game more than three days a week and 77.4% practice stress relieving activities like yoga/exercises more than three times in a week. The study done by Ankolekar et al shows that Yoga and meditation improves the cardiovascular functions and normalize the high normal blood pressure of subjects with prehypertension. Hence, it can be a useful tool to keep the person healthy throughout the life if it is practiced regularly.¹¹ Despite the multitude of potential health benefits derived from regular physical activity, one-third of many adult populations (about 1.5 billion people globally) and four-fifths of adolescents do not adhere to minimum recommended levels of moderate-vigorous physical activity.¹¹ The studies suggest that even moderate increases in time spent in physical activity could be a potentially important strategy to reduce the prevalence of elevated BP. The yoga interventions lasting eight weeks or more, reduced SBP on average by 9.65 mmHg.¹² As the MBBS course progress there are long hours of study and emergency duties which leads to sedentary life style and stress of exams further exerbate the development of disease like hypertension. Since most of students are also engased in physical activities, Yogic practices and very few are smoker and consuming alcohol so they have to continue with these good health promotion activities.

CONCLUSION

Pre-hypertension, consumption of high salt containing food, less intake of fruits and vegetables, obesity, physical inactivity, consumption of alcohol and smoking are modifiable risk factors of hypertension in youth. There were also good habits among the MBBS students which needs to be continued in future also. The awareness activities for prevention and control of hypertension and other non-communicable diseases should be started from primary school level. There is need to robust implementation of screening programs for non-communicable diseases.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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