Prevalence of hypertension among medical students and its lifestyle determinants

Mahasin Ali Al-Taha; Ahmed K Al-Delaimy; Ru'ya Abdulhadi Alrawi

doi:10.4103/IRJCM.IRJCM_9_21

ORIGINAL ARTICLE

Year : 2020 | Volume : 33 | Issue : 2 | Page : 85-89

Prevalence of hypertension among medical students and its lifestyle determinants

Mahasin Ali Al-Taha, Ahmed K Al-Delaimy, Ru'ya Abdulhadi Alrawi
Department of Family and Community Medicine, Medical College, Al-Anbar University, Ramadi, Iraq

Date of Submission	11-Dec-2020
Date of Decision	25-Dec-2020
Date of Acceptance	30-Dec-2020
Date of Web Publication	6-Jul-2023

Correspondence Address:
Dr. Mahasin Ali Al-Taha
Department of Family and Community Medicine, Medical College, Al-Anbar University, Ramadi
Iraq

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IRJCM.IRJCM_9_21

Abstract

Background: Hypertension is a major public health problem worldwide. It is a risk factor for most coronary heart diseases and cardiovascular diseases. Strategies to prevent and treat hypertension in younger age groups and adolescents, including medical students, have been applied and evaluated by the World Health Organization. Objectives: The objective of the study is to determine the prevalence of both hypertension and prehypertension among medical students in medical colleges and to study the association of different factors with hypertension disease. Methodology: A descriptive cross-sectional study was conducted in medical colleges of Al-Anbar University, Iraq. The study period was from January 1 to March 10, 2019. A total of 273 undergraduate medical group students, both female and male, participated in this study from three colleges: medicine, pharmacy, and dentistry colleges. Blood pressure, height, and weight were measured using standardized instruments. SPSS Statistics for Windows, Version 24.0 was used to analyze data. Both cross-tabulation and Chi-square tests of significance were done. Results: The prevalence rate of hypertension in this research study was 9.9%, of them 18.0% and 3.3% were male and female, respectively. Prehypertension was 17.2% of the total sample. Risk factors highly associated with hypertension (P = 0.0001) were male gender, stress, high salt intake, smoking habits, and increased body mass index. However, there was no significant association between dietary risk factor and hypertension in our study. Conclusion: The high overall prevalence of hypertension (9.9%) and prehypertension (17.2%) with overall prevalence of hypertension and prehypertension together (27.1%) represents a call for the establishment of screening system for early detection at primary health-care level. Community-based health education programs on the importance of the examination and follow-up processes for early detection of hypertension and prehypertension are recommended.

Keywords: Hypertension, medical students, prevalence, prehypertension

How to cite this article:
Al-Taha MA, Al-Delaimy AK, Alrawi RA. Prevalence of hypertension among medical students and its lifestyle determinants. IRAQI J COMMUNITY MED 2020;33:85-9

How to cite this URL:
Al-Taha MA, Al-Delaimy AK, Alrawi RA. Prevalence of hypertension among medical students and its lifestyle determinants. IRAQI J COMMUNITY MED [serial online] 2020 [cited 2023 Oct 2];33:85-9. Available from: http://www.journalijcm.org/text.asp?2020/33/2/85/380717

Introduction

Hypertension is a serious community health problem worldwide. More than nine million deaths annually related to hypertension disease. Through routine medical investigations, a lot of patients of hypertension are detected accidently.^[1],[2]

Prehypertension in young adults increases the probability for developing hypertension in older ages. Hypertension increases the risk of different critical health illness, for example, cardiovascular diseases and stroke, kidney failure, and eye diseases. It is noticed that lifestyle in a lot of regions in the world has been changed from traditional to modern life. This matter led to young people and adolescence suffering from hypertension due to fast food, sedentary lifestyle, advanced technology, and other modified life and dietary style characterized by low physical activity and increased diets of high calories, which are rich in fat and sugar.^[3]

Hypertension is related to increased chance of coronary heart diseases and myocardial infarction; this happens to a lower risk with prehypertension people. Mild elevation of blood pressure leads to increased thickness of wall of arteries. The early discovering of hypertension is important in the identification of factors that can be modified for prevention of cardiovascular diseases, as Qureshi et al. mentioned in their study.^[4]

Several studies have reported different prevalence rate of hypertension among medical students ranging between 6% and 21.3%.^[5],[6],[7] Nonmodifiable risk factors such as gender (male), older age, and positive family history were found to be associated with hypertension, while various modifiable risk factors were found to be linked with hypertension, including lack of physical activity, tobacco smoking, alcohol consumption, and higher body mass index (BMI).^[1],[8],[9]

Dietary attitudes were also found associated with hypertension, for example, low consumption of fruits and vegetables^[10] and consuming fat foods^[11] and fast foods.^[12]

The aim of this study is to determine the prevalence of hypertension and prehypertension among medical students in three medical group colleges and the relationship between different factors with hypertension.

Methodology

This is a descriptive, cross-sectional study that was carried out on medical colleges of Al-Anbar University. A total of 273 medical students were included in this study (122 males and 151 females) from three colleges: medicine, pharmacy, and dentistry colleges. The study period was from January 1 to March 10, 2019. Participants who have certain diseases and on medications such as corticosteroids were excluded. Privacy and confidentiality were considered. Participants were given the right to withdraw from the study at any time.

Data on sociodemographic characteristics were collected from participant students. Further, lifestyle factors include cigarette smoking, physical activity, and dietary habits. Weight was measured using a digital scale to the nearest 0.1 kg with only light clothing, and for the determination of height, subjects were asked to take off their shoes, stand upright with their head up and the heel, buttock, and occiput against the wall. Height was recorded to the nearest 0.5 cm. BMI was calculated using the formula: “weight (Kg)/height² (m).

Blood pressure was measured using a standard mercury sphygmomanometer on two different times, with at least 10 min gap; the average reading was considered as the final reading. Student was guided to sit in 90° sitting position, and prehypertension was defined as systolic blood pressure 120–139 mmHg or diastolic blood pressure 80–89 mmHg. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. BMI was classified according to the WHO Adult BMI Classification into normal (18.5–24.9), overweight (25–29.9), and obese (≥30).^[10]

Collected data were coded and analyzed using It is an international software for statistical analysis, USA. Windows), Version 24.0. Cross-tabulation and Chi-square test of significance were done between all factors studied as age, gender, BMI, physical activity, fruits and vegetables intake, and family history of hypertension with the prevalence of prehypertension and hypertension. P ≤ 0.05 was considered the level of significance. Logistic regression was done to demonstrate the effects of risk factors on hypertension.

Results

The study's participants consisted of 273 medical students (mean age 20.8 ± 1.75, range = 18–25 years), 122 of which (44.7%) were male and 151 (55.3%) were female. [Table 1] shows the sociodemographic characteristics of the study participants. The students enrolled were from College of Medicine (44.3%), College of Pharmacy (24.5%), and College of Dentistry (31.1%). According to the educational year, 23.4%, 24.9%, 21.2%, 14.7%, 9.9%, and 5.9% of the study participants were enrolled in the 1^st, 2^nd, 3^rd, 4^th, 5^th, and 6^th year of medical schools, respectively. The residence of more than two-thirds of the students (68.5%) were in hostels, 25.6% with their families at home, while only 5.9% rent houses with others.

Table 1: The distribution of medical students according to sociodemographic characteristics (n=273)

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[Figure 1] shows that 27 out of 273 students were having hypertension according to the JNC-7 Definition of Prehypertension and Hypertension; thus, the prevalence of hypertension in the study sample was found to be 9.9%, of them 22 (18.0%) were male and 5 (3.3%) were female.

Figure 1: Shows the Prevalence of Hypertension and Prehypertension among the study sample.

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Prehypertension was detected among 47 students constituting 17.2% of the total sample (25.4% males and 10.6% females). The other 72.9% of the students were having normal blood pressure.

Risk factors of hypertension are illustrated in [Table 2]. Smokers constituted 11.7% among all medical students, physical inactivity (both mild and sedentary) was found in 65.9%, while only 12.8% were having exercises 5 days or more in a week. Positive family history of hypertension was found among 46.2%. More than half of the sample (55.7%) said that sometimes they had psychosocial stress, while 16.8% were always under such stress. Overweight and obesity prevalence was 37.0% among students (28.9, 8.1%). Time spent on mobile per day was 5 h and more by nearly 40% of all students, 3–4 h by 36.6%, and only 1–2 h by 23.4%. Regarding dietary risk factors, 10.6% of the students have a lot of salt intake, 20.5% have too much tea and coffee per day, and 7.0% had high calorie drinks. Other dietary intake includes vegetable consumption; 68.1% had consumed vegetables less than 7 days/week, 42.9% consumed fruits <3 days/week. On the other hand, fast food, soft drinks, and fatty food were consumed by 54.9%, 54.6%, and 66.3%, accordingly.

Table 2: Distribution of medical students according to risk factors of hypertension

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[Table 3] demonstrates the relationship between hypertension, prehypertension, and various risk factors. The association was significant with increasing age, gender (male had more prevalence than female), residence at hostels or in rent places with others, smoking habits, positive family history, physical inactivity, psychosocial stress, high salt intake, and obesity. Dietary risk factors were not found to be significantly associated with hypertension in our study.

Table 3: Association of risk factors with hypertension and prehypertension

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In [Table 4], logistic regression reveals that gender, physical inactivity, stress, excess salt intake, and high BMI are significantly associated with hypertension.

Table 4: Logistic regression of risk factors affecting hypertension

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Discussion

The overall prevalence of hypertension in this study was 9.9% (18.0% and 3.3% in male and female, respectively) and prehypertension prevalence of 17.2%. The overall prevalence of hypertension and prehypertension together is 27.1%, which is similar to the prevalence of hypertension and prehypertension together found in a study in Palestine^[13] but lower than that reported by Alanazi et al. in Saudi Arabia, which was 56.89%.^[14]

The prevalence of hypertension alone in this study is 9.9% among medical students, which is similar to that reported by Ghazi et al. in Malaysia (10%)^[15] but lower than that reported among medical students in the Al-Qassim Province of Saudi Arabia (14.6%)^[16] and in Uganda (14%).^[6]

The risk factors associated with hypertension which have significantly associated with hypertension are sedentary lifestyle, gender (male), high consumption of salt, cigarette smoking, obesity, and stress. Several studies reported higher prevalence of hypertension among males compared to females.^[16],[17] This difference in the prevalence rate by gender is still unclear; however, the role of androgens in regulating blood pressure gives some clue to differences between genders.^[18]

An association between BMI and hypertension was found in this report. The prevalence of hypertension was found to be 45% among obese participants (BMI ≥30) which is similar to another study that reported 45.48% of hypertensive having high BMI.^[19] Other studies had shown BMI to be a strong predictor of hypertension.^[16],[20] Although the exact mechanism by which increased body weight leads to hypertension is still unclear, a previous research suggest that in obese people, the combination of insulin resistance, increased sympathetic activity, and increased leptin levels could be the mechanism behind this.^[21]

This study showed that current smoking is also a significant risk factor for hypertension, which is in agreement with other studies through the stimulation of the sympathetic nervous system; smoking has hypertensive effect.^[22],[23] Medical students undergo a lot of psychological distress, especially during initial years of training, which has been demonstrated by various studies.^[24],[25] Furthermore, high salt intake was found significantly associated with elevated blood pressure; this is in agreement with other studies.^[26],[27]

Unlike previous studies,^{[15],[18],[28]} this study did not find significant association between inadequate vegetable and fruit consumption, soft drink, fatty foods, fast food consumption, and hypertension.

The limitation of this study is that follow-up was not conducted for those with high blood pressure. In conclusion, the high overall prevalence of hypertension (9.9%) and prehypertension (17.2%) with overall prevalence of hypertension and prehypertension together (27.1%) represents a call for the establishment screening system for early detection at primary health-care level. Participation in sports should be recommended for all medical students to prevent them going toward the tendency of physical inactivity. One of the primary prevention of hypertension is a call for lifestyle modification from younger age, to introduce the importance of balanced diet and avoid salty food and regular exercise.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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