Indian Journal of Medical Research

: 2018  |  Volume : 148  |  Issue : 6  |  Page : 752--755

A cross-sectional study on pre-hypertension & its association with anthropometric indices among undergraduate medical students in Andhra Pradesh, India

P Likhita Bhavani1, Sandhya Gupta2, Sharmilakrishna Thanikonda3, Venkatarao Epari4,  
1 Narayana Medical College, Nellore 524 003, Andhra Pradesh, India
2 Department of Physiology, Institute of Medical Sciences & Sum Hospital, Siksha ‘O’ Anusandhan Deemed University, Bhubaneswar 751 003, Odisha, India
3 Department Biochemistry, Narayana Medical College, Nellore 524 003, Andhra Pradesh, India
4 Department of Community Medicine, Institute of Medical Sciences & Sum Hospital, Siksha ‘O’ Anusandhan Deemed University, Bhubaneswar 751 003, Odisha, India

Correspondence Address:
Sandhya Gupta
Department of Physiology, Institute of Medical Sciences & Sum Hospital, Siksha ‘O’ Anusandhan Deemed University, Bhubaneswar 751 003, Odisha

How to cite this article:
Bhavani P L, Gupta S, Thanikonda S, Epari V. A cross-sectional study on pre-hypertension & its association with anthropometric indices among undergraduate medical students in Andhra Pradesh, India.Indian J Med Res 2018;148:752-755

How to cite this URL:
Bhavani P L, Gupta S, Thanikonda S, Epari V. A cross-sectional study on pre-hypertension & its association with anthropometric indices among undergraduate medical students in Andhra Pradesh, India. Indian J Med Res [serial online] 2018 [cited 2020 Sep 26 ];148:752-755
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Full Text


Hypertension (HTN) is an emerging public health concern in India owing to steady increase in prevalence across the past few decades[1], especially in urban communities with wide geographic variation[2]. HTN develops gradually preceded by pre-HTN as evidenced by longitudinal studies demonstrating a three-fold increased incidence among participants of pre-HTN as compared to their counterparts[3]. The Seventh Report of the Joint National Committee (JNC 7)[4] defined pre-hypertension as persons with blood pressure (BP) above optimal levels [systolic BP (SBP) of 120-139 mm Hg or diastolic BP (DBP) of 80-89 mm Hg]. Community-based studies in India have demonstrated close to a third of the studied population with pre-HTN[5],[6],[7].

While most studies focused on HTN among older adults and elderly, some studies suggested that HTN was seen more commonly among younger population due to 'Globesity' (global epidemic of overweight and obesity)[8],[9]. Thus, an attempt was made to estimate the prevalence of pre-HTN among medical undergraduate students and its association with anthropometric measurements.

A cross-sectional study was conducted among first year medical students (2015-2016) of Narayana Medical College, Nellore, Andhra Pradesh, India, following approval by the Institutional Ethics Committee. Apparently healthy students who consented (informed and written) to participate and were present on the day of the study were included in the study. Participants with known HTN/cardiovascular diseases and on drugs that would affect the parameters, were excluded from the study. Data were collected using pre-designed and pre-tested questionnaire on age, gender, type of diet (vegetarian or mixed), physically active (engaging in non-occupational physical activity for >150 min a week), family history of HTN, consumption of alcohol/smoking and on medications. BP was recorded with a calibrated mercury sphygmomanometer following standard procedure and was classified according to the eighth report of JNC 8 criteria[10]. Normal BP was defined (mm Hg) as SBP <120 and DBP <80. SBP of 120-139 and/or DBP of 80-89 mm Hg was classified as pre-HTN, SBP 140-159 and DBP of 90-99 as Stage I HTN and SBP >160 and DBP >100 as Stage II HTN. Height was measured with a stadiometer following standard procedure to the nearest 0.01 kg, on a load cell-operated calibrated digital scale. BMI (weight in kg/height in m2) <18.5 was considered as underweight, 18.5-22.9 as normal weight, 23-27.5 as overweight and BMI ≥27.5 as obese[11]. Waist circumference (WC) and hip circumference (HC) were measured in centimeter following standard procedure using a stretch-resistant tape. Waist hip ratio (WHR) was calculated.

Statistical analysis was performed using SPSS version 20.0 software (IBM Corp., Armonk, NY, USA). Prevalence of pre-HTN was calculated according to formula (Number of cases of pre-HTN/study population×100). Participants were divided into two groups: normotensive and pre-hypertensive groups. Continuous variables are expressed as mean±standard error of the mean. Comparison of continuous variables between the two groups was made using Student's t test. Association of factors such as gender, place of stay, excess salt intake and family history of BP was done using Chi-square test. Binary logistic regression analysis was performed using pre-HTN as dependent and other variables which were significantly associated with pre-HTN as independent variables.

Of the 250 students, 210 participated in the study and three students were excluded based on exclusion criteria. The mean (±standard deviation) age of the participants was 18.53±0.84 yr (range: 17-21 yr). The prevalence of pre-HTN was 15.9 per cent (33/207, males: 29.3% and females: 5.2%). None were hypertensive. Prevalence of overweight and obesity was 43 per cent (n=89) and underweight was 12.6 per cent (n=26). In univariate analysis [Table 1], only male gender with higher odds of pre-HTN was associated at significant level. Further, pre-hypertensive students had significantly higher values of anthropometric indices [BMI (22.3±0.29 vs. 26.6±1.05 kg/m2), WC (78.3±0.75 vs. 88.9±2.66 cm), HC (94.1±0.65 vs. 103.4±2.09 cm) and WHR (0.82±0.003 vs. 0.85±0.01)] as compared to their counterparts. Multivariable binary logistic regression analysis was carried out to assess the relative contribution of significant independent variables (age, WHR, BMI and gender), which showed [Table 2] gender and BMI significantly contributing in determining pre-HTN.{Table 1}{Table 2}

Almost one-third of the general population in our study setting[12] were reported to be hypertensive. To tackle the growing epidemic of HTN, assessment of the prevalence of pre-HTN in any community warrants utmost priority owing to its associated risk of developing HTN[3]. Relatively, lower prevalence (15.9%) of pre-HTN was noted in our study similar to the findings from Kolkata (19.18%)[13] but in contrast to studies conducted among medical undergraduates within Andhra Pradesh (37.45%)[14], Agartala (45%)[15], Chennai (46.7%)[16] and Karnataka (55.4%)[17]. Prevalence of pre-HTN was higher among males as was observed by other researchers[6],[15],[16] also.

In the present study, pre-hypertensives had higher BMI, WC and WHR, indicating that overweight and obesity were major accompaniments before the development of HTN in accordance with other studies[18]. Overweight and obesity calculated by BMI were demonstrated as independent risk factors for the development of pre-HTN and cardiovascular disease[5],[19] in India. Similarly, WC and WHR as a measure of abdominal/central obesity are also found to be a risk factor[20].

On logistic regression analysis, male gender and BMI were found to be significantly associated with pre-HTN. Similar to our findings, a few other studies have observed an independent association between BMI with either SBP or DBP among medical students[21],[22]. Although WHR showed independent association, it was not significant in our study in contrast to the independent relationship noted between WHR and either systolic or DBP by a few others[21],[22], which could be attributed to a small number of participants. In conclusion, about 16 per cent medical and graduate students had pre-HTN in our study. In view of the growing burden due to HTN, early intervention for lifestyle changes is needed.

Acknowledgment: Authors acknowledge the cooperation extended by the participating students.

Financial support & sponsorship: Authors acknowledge the Indian Council of Medical Research, New Delhi, for providing financial support to the first author (BPL) in the form of Short Term Studentship.

Conflicts of Interest: None.


1Premkumar R, Pothen J, Rima J, Arole S. Prevalence of hypertension and Pre-hypertension in a community-based primary health care program villages at central India. Indian Heart J 2016; 68 : 270-7.
2Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E, et al. Hypertension in India: A systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens 2014; 32 : 1170-7.
3Ferguson TS, Younger N, Tulloch-Reid MK, Lawrence-Wright MB, Forrester TE, Cooper RS, et al. Progression from Pre-hypertension to hypertension in a Jamaican cohort: Incident hypertension and its predictors. West Indian Med J 2010; 59 : 486-93.
4National Heart Lung and Blood Institute. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Bethesda: National Institutes of Health; 2004. Available from:, accessed on January 1, 2018.
5Yadav S, Boddula R, Genitta G, Bhatia V, Bansal B, Kongara S, et al. Prevalence & risk factors of pre-hypertension & hypertension in an affluent North Indian population. Indian J Med Res 2008; 128 : 712-20.
6Asmathulla S, Rajagovindan D, Sathyapriya V, Pai B. Prevalence of Pre-hypertension and its relationship to cardiovascular disease risk factors in Puducherry. Indian J Physiol Pharmacol 2011; 55 : 343-50.
7Rao CR, Kamath VG, Shetty A, Kamath A. High blood pressure prevalence and significant correlates: A quantitative analysis from Coastal Karnataka, India. ISRN Prev Med 2013; 2013 : 574973.
8Anyaegbu EI, Dharnidharka VR. Hypertension in the teenager. Pediatr Clin North Am 2014; 61 : 131-51.
9World Health Organization. Controlling the global obesity epidemic. Nutrition health topics. Geneva, Switzerland: WHO; 2013. Available from:, accessed on March 1, 2017.
10Hernandez-Vila E. A review of the JNC 8 Blood Pressure Guideline. Tex Heart Inst J 2015; 42 : 226-8.
11WHO expert consultation. Appropriate body-mass Index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363 : 157-63.
12Prabakaran J, Vijayalakshmi N, Venkatarao E. Prevalence of hypertension among urban adult population (25-64 years) of Nellore, India. Int J Res Dev Health 2013; 1 : 42-9.
13Chattopadhyay A, Taraphdar P, Kumar SB, Maulik S, Ghosh R, Sinha A, et al. A study on prevalence of hypertension and its related risk factors among undergraduate medical students in Kolkata. IOSR J Dent Med Sci 2014; 13 : 1-7.
14Chitrapu RV, Thakkallapalli ZM. Pre-hypertension among medical students and its association with cardiovascular risk factors. J NTR Univ Health Sci 2015; 4 : 8-12.
15Debbarma A, Bhattacharjya H, Mohanty A, Mog C. Prevalence of pre-hypertension and its relationship with body mass index among the medical students of Agartala government medical college. Int J Res Med Sci 2015; 3 : 1097-101.
16Thilip Kumar G, Prabhavathi K, Karthick N, Poornima K, Saravanan A. Evaluation of Pre-hypertension and its associated factors among 1st year medical students. Asian J Pharm Clin Res 2014; 7 : 32-5.
17Shetty SS, Nayak A. Prevalence of pre-hypertension amongst medical students in coastal Karnataka. J Evol Med Dent Sci 2012; 1 : 975-80.
18Al-Sharbatti S, Shaikh R, Mathew E, Sreedharan J, Muttappallymyalil J, Basha S, et al. The use of obesity indicators for the prediction of hypertension risk among youth in the United Arab emirates. Iran J Public Health 2011; 40 : 33-40.
19Das SK, Sanyal K, Basu A. Study of urban community survey in India: Growing trend of high prevalence of hypertension in a developing country. Int J Med Sci 2005; 2 : 70-8.
20Ferdinand KC, Pacini RS. New evidence confirms risks associated with prehypertension and benefits of therapeutic lifestyle changes in management. J Cardiometab Syndr 2007; 2 : 302-4.
21Zafar S, Ul Haque I, Butt AR, Mirza HG, Shafiq F, Ur Rehman A, et al. Relationship of body mass index and waist hip ratio measurement with hypertension in young adult medical students. Pak J Med Sci 2007; 23 : 574-9.
22Bertsias G, Mammas I, Linardakis M, Kafatos A. Overweight and obesity in relation to cardiovascular disease risk factors among medical students in Crete, Greece. BMC Public Health 2003; 3 : 3.