Sustained hypertension among urban schoolchildren on the rise: Experts

A study conducted by Dr Bishav Mohan, Dr Gurpreet Singh Wander, Dr Naveen Kumar, Dr Naved Aslam, Dr Aditya Rangbulla, Dr S Kumbkarni and Dr Naresh K Sood from Dayanand Medical College and Hospital’s Department of Cardiology, Ludhiana, has found that high blood pressure (BP) and obesity among adolescents, in conjunction with many of their health consequences such as dyslipi-daemia, abnormal plasma glucose and metabolic disorders, have dramatically increased over the past two decades worldwide due to the rapid socioeconomic, nutritional and epidemiological transitions. The early detection of these cardiovascular risk factors (hypertension and obesity) is an important public health priority as it may possibly prevent the adverse consequences of cardiovascular diseases in adulthood.

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The increasing trend of hypertension is a worldwide phenomenon. The data on sustained hypertension in school-going children is scanty in India.

The present study was conducted to evaluate the prevalence of sustained hypertension and obesity in apparently healthy school children in rural and urban areas of Ludhiana using standard criteria.

Selection of schools and study participants: Ludhiana district has a total of 1,864 schools, out of which 317 are in the urban and 1,547 in rural areas. The schools were selected by simple random sampling strategy, considering the population proportion to sample size and within the 2 km vicinity of the schools which were included in the first cross-sectional study conducted in 2004. Then a stratified sampling strategy was used to select children (adolescents) aged 11–17 in a given school, considering each class as strata and equally dividing the required sample size for that school among all classes. From each class, the students were again selected by simple random sampling method.

Methods and results:

A total of 2,467 apparently healthy adolescent schoolchildren aged between 11-17 from an urban area and 859 students from a rural area were taken as subjects. Out of the total 3,326 students, 189 were found to have sustained hypertension; in urban areas, the prevalence of sustained hypertension was 6.69% (n=165) and in rural area, it was 2.56% (n=24). Males outnumbered females in both rural and urban areas. The mean systolic and diastolic blood pressure of hypertensive population in both urban and rural population was significantly higher than systolic and diastolic blood pressure in their normotensive (having or denoting a normal blood pressure) counterparts.

Overweight population was significantly higher in the urban area. There were 287 (11.63%) overweight students and 58 (2.35%) were obese. In the rural population, overweight and obese students were 44 (4.7%) and 34 (3.63%), respectively. There was a significant increase in the prevalence of hypertension in both rural and urban population with increased body mass index in urban students; those with normal body mass index had prevalence of hypertension of 4.52%, in overweight it was 15.33% and in obese, it was 43.10%.

In the rural area, the overweight students showed prevalence of sustained hypertension in 6.82% and in obese group it was 61.76. No student with normal body mass index in rural area was found to be hypertensive. The mean body mass index of hypertensive population in both rural and urban areas was significantly higher than respective normotensive population.

Conclusions:

The prevalence of sustained hypertension is on the rise in urban areas even in younger age groups. Blood pressure is frequently elevated in obese children compared to lean subjects. This is possibly related to their sedentary lifestyle, altered eating habits, increased fat content of diet and decreased physical activities.