Hypertension and obesity in adults: evidence from a cross-sectional study at a tertiary care hospital in Punjab

INTRODUCTION

India's healthcare landscape is grappling with the dual challenge of hypertension and obesity, which continues to pose significant public health concerns despite notable advancements in healthcare and policy implementation.

The World Health Organization (WHO) identifies them as major modifiable risk factors for cardiovascular diseases, stroke, diabetes, and chronic kidney disorders. Worldwide, an estimated 1.28 billion adults aged 30–79 years are hypertensive, with the majority living in low- and middle-income countries, while obesity has nearly tripled since 1975, affecting over 650 million adults. To combat this growing health challenge, global efforts aim to reduce hypertension prevalence by 33% by 2030, underscoring the need for enhanced awareness, detection, and management strategies.¹

Obesity is also a significant concern, with the prevalence of overweight and obesity increasing by 35.6% and 24.7%, respectively, between 1990 and 2016.² The economic burden of hypertension and obesity is substantial, with estimates suggesting that India loses approximately 6.2% of its GDP annually due to non-communicable diseases.³

A study published in The Lancet estimated that the total cost of hypertension in India was approximately ₹1.4 trillion (USD 19.5 billion) in 2016, with a significant proportion of these costs being borne by households.⁴

According to the latest data from the National Family Health Survey (NFHS) 2023, approximately 33.8% of adults in urban areas live with hypertension, while around 27.6% of adults in rural areas live with hypertension.⁵ Another study focusing on adults aged 15-49 years found a prevalence of 12.5% in urban areas and 10.6% in rural areas.⁶ Similarly, the prevalence of obesity has been increasing, with 20.7% of adults in urban areas and 13.4% in rural areas being obese.⁷

Therefore, this study was undertaken to assess the burden of hypertension and obesity among adults attending a tertiary care hospital in Punjab, with the aim of generating evidence that could guide interventions to reduce the risk of associated complications and improve overall health outcomes.

Primary objective was to estimate the prevalence of hypertension and obesity among adults visiting tertiary care hospital of Bathinda, Punjab.

Secondary objective was to find out the correlation of hypertension and obesity among patients visiting tertiary care hospital of Bathinda, Punjab.

METHODS

Study design and setting

This cross-sectional study was conducted at a tertiary care hospital (AIIMS) of Bathinda, Punjab, India. The study was carried out in the year 2023.

Study population

The study population consisted of adults (18-60 years) visiting various outpatient departments (OPDs) at tertiary care hospital (AIIMS) Bathinda. Adults of all ages and genders were included in the study.

Sampling technique and sample size

All those eligible and willing to participate were included consecutively and total 265 Adults were screened on the occasion of World Heart Day 2023.

Inclusion and exclusion criteria

Adults who visited the OPDs aged 18-60 years and were willing to participate included in the study, and adults who were critically ill or pregnant females were excluded from the study.

Ethical consideration and data collection

Written Informed consent was taken from the study participants. A team of trained researchers collected data from the study participants using a pre-designed questionnaire. The questionnaire included questions on medical history and anthropometric measurements such as height, weight, and blood pressure were recorded. The data was analyzed using statistical package for the social sciences (SPSS) version 23.

Anthropometric measurements

Body weight was measured through an analogue medical scale. Body height was measured using a standard stadiometer. Body weight and height were measured to the nearest 0.1 kg and 0.1 cm, respectively.

BMI was defined as weight (kilograms) divided by the square of height (meters). The BMI cutoffs recommended by the WHO were used. The classes of BMI reported by the WHO are: >18.5 kg/m² underweight, 18.5–24.9 kg/m² for normal, 25.0–29.9 kg/m² for overweight, and >30 kg/m², for obesity.⁸

Blood pressure measurements were obtained from all participants after a 5-minute resting period in a seated position and were asked about recent consumption of coffee, nicotine, or other substances that may affect blood pressure readings. Measurements were taken at 30 seconds intervals between cuff inflations, and an average of three measurements was used to ensure accuracy. All measurements were performed in a dedicated area with optimal room temperature and respect for participant privacy.

The World Health Organization (WHO) and International Society of Hypertension (ISH) 1999–2003 guidelines categorizes blood pressure (BP) for adults (≥18 years) as follows.^9,10

Medical history and lifestyle assessment

Before participating in the study, each participant underwent a comprehensive medical history and lifestyle assessment to identify potential factors that may influence blood pressure readings. Specifically, inquiries were made regarding the following.

Pre-existing medical conditions

Participants were asked if they had a prior diagnosis of hypertension (high blood pressure), diabetes mellitus, anemia, high cholesterol, or kidney disease.

Medication use

Participants were asked if they were currently taking any medications that may affect blood pressure.

Cardiovascular history

Participants were asked if they had a history of heart attack, stroke, or other cardiovascular events.

Lifestyle habits

Participants were asked about their smoking habits, and use of tobacco products.

Other relevant factors

Participants were also asked about other factors that may impact blood pressure.

RESULTS

Table 1 revealed the demographic data that the study population consisted of 63% males and 37% females, with the majority (42.3%) falling within the 32-45-year age group. Most of them were not having personal history of high BP, diabetes, medication use, anemia, high cholesterol, heart attack, stroke, kidney diseases, smoking and tobacco.

Figure 1 depicts BMI categories of patients i.e. about 36.9% of the patients were overweight and 18.9% of them were obese. Majority (38.5%) of patients were normal and only 5.7% of them were underweight.

Table 2 depicts the blood pressure classification revealed that 18.2% (n=48) of the participants had normal blood pressure, while 22.6% (n=60) were pre-hypertensive. Furthermore, 21.9% (n=58) were classified as having stage 1 hypertension, 24.2% (n=64) as stage 2 hypertension, and 13.4% (n=35) as stage 3 hypertension.

Table 3 showing the correlation of hypertension with obesity was found statistically significant (r=0.230) as p value <0.01 level of significance calculated through Karl Pearson correlation coefficient.

DISCUSSION

The present cross-sectional study evaluated the prevalence of hypertension and obesity among adults attending a tertiary care hospital in Bathinda, Punjab, and examined the association between these two major non-communicable disease risk factors. The findings reveal a substantial burden of both conditions, highlighting an important public health concern within this population.

A large proportion of participants demonstrated elevated blood pressure levels, including those classified as pre-hypertensive and hypertensive. Most individuals belonged to the 32–45 years and 46–60-year age groups, indicating that middle-aged adults are particularly vulnerable to hypertension and excess body weight. This observation is consistent with longitudinal evidence indicating a progressive rise in blood pressure with advancing age, particularly when accompanied by increased body weight.^11,12

Multimorbid conditions were also noteworthy, with diabetes present in 9.4% of participants, dyslipidemia in 12.8%, and kidney disease in 7.5%. These findings are consistent with the report by Dalal et al, which demonstrated that the coexistence of hypertension, type 2 diabetes, and dyslipidemia substantially increases cardiovascular and metabolic risk.¹³ The present findings also align with Raheja et al, who reported a significant association between increased body mass index and hypertension, identifying obesity as a major contributor to elevated blood pressure.¹⁴

Despite the high prevalence of hypertension, only 28.3% of participants were receiving antihypertensive medication, highlighting gaps in awareness, initiation of treatment, and long-term adherence. Similar findings have been reported by Sudharsanan et al, who documented substantial treatment discontinuation and irregular antihypertensive drug intake among diagnosed adults in urban India.¹⁵

In the current study, 22.6% of adults were pre-hypertensive, while 21.9–24.2% had stage 1–2 hypertension. In contrast, Geevar et al reported 33.3% pre-hypertension and 11.2% hypertension among young adults in Kerala, suggesting higher pre-hypertension but lower clinical hypertension in younger populations.¹⁶

Notably, 24.2% and 13.4% of participants were found to have stage 2 and stage 3 hypertension, respectively, conditions associated with a high risk of cardiovascular and renal complications. This is supported by hospital-based evidence from Kashmir, where hypertensive patients exhibited high rates of stroke, diabetes, dyslipidemia, kidney disease, and heart disease, underscoring the severe morbidity associated with advanced or poorly controlled hypertension.¹⁷ Overweight and obesity were prevalent in the study population, with 36.9% classified as overweight and 18.9% as obese. Comparable rates of abdominal obesity have been reported among adults in Ludhiana district, supporting the widespread nature of excess body weight across Punjab.¹⁸

A statistically significant positive correlation was observed between obesity and hypertension (r=0.230, p<0.01), indicating that higher body mass index is associated with increased blood pressure. This observation is consistent with national urban trends and large pooled analyses demonstrating strong associations between both general and abdominal adiposity and hypertension across diverse populations.^11,12

In conclusion, the present study highlights the prevalence of hypertension and obesity along with reinforcement of significant co-relation between obesity and hypertension among adults attending a tertiary care hospital. Although the observed correlation was moderate, it is clinically meaningful and highlights the importance of weight management strategies in the prevention and control of hypertension.

Limitations

Sample may not be representative of the general population of setting due to opportunistic research. There can be self- reported biases in reporting of lifestyle habits, and medical history.

CONCLUSION

This study emphasizes the need for comprehensive hypertension management and prevention strategies in India, particularly among high-risk groups such as middle-aged individuals and those with obesity/overweight. Targeted interventions, health literacy enhancement, and financial and logistical support are crucial to improving hypertension outcomes and reducing the burden of cardiovascular disease. Policymakers and healthcare providers should prioritize these strategies to address the growing burden of hypertension and obesity at regional and national level.

Funding: No funding sources

Conflict of interest: None declared

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

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