European Journal of Cardiovascular Medicine

Hypertension, commonly known as high blood pressure often referred to as the "silent killer," poses an ongoing threat to global health. It is a major risk factor for cardiovascular diseases and contributes significantly to morbidity and mortality rates. However, the focus on hypertension often neglects its precursor condition – pre-hypertension. “Prehypertension" is defined as having a systolic blood pressure of 120–139 mm Hg or a diastolic blood pressure of 80–89 mm Hg in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7)[1] Individuals who are currently having pre-hypertension are more likely to develop hypertension in future irrespective of other cardiovascular risk factors." Pre-hypertension is significantly linked to a higher chance of developing type-2 diabetes and chronic kidney disease [2,3], as well as an increased risk of myocardial infarction and coronary artery disorders [4]. Screening for metabolic syndrome and preventing cerebrovascular accidents are significantly aided by the early detection of pre-hypertension.Recognizing prehypertension is crucial as it offers an opportunity for early intervention and prevention of further complications 

Medical undergraduates, being future healthcare professionals, are not immune to this growing health issue. Their lifestyle choices and academic stress may predispose them to develop prehypertension at an alarming rate. Understanding the prevalence of prehypertension among medical undergraduates can provide valuable insights into their overall health status and potential risks they may face in the future.

This article embarks on a journey into the world of prehypertension, with a specific focus on an often-overlooked population: Medical undergraduates. The prevalence of prehypertension among medical undergraduates is a growing concern, highlighting the need to identify the risk factors associated with this condition in this specific population. Several factors have been identified that contribute to the development of prehypertension among medical undergraduates. Firstly, lifestyle choices play a significant role, with sedentary behaviour and lack of regular physical activity being common risk factors.[5]Additionally, unhealthy dietary habits such as high sodium intake and low consumption of fruits and vegetables have been linked to prehypertension.[6] Furthermore, stress levels among medical undergraduates are notably high due to academic pressures, which can lead to elevated blood pressure levels. Other contributing factors include a family history of hypertension, obesity or excessive weight gain, smoking habits, and alcohol consumption.Understanding these risk factors is crucial for implementing preventive strategies and interventions that can effectively address prehypertension in this population while promoting healthier lifestyles and overall well-being. Prehypertension, a condition characterized by blood pressure levels slightly higher than normal, poses significant health risks for medical undergraduates. Firstly, it increases the likelihood of developing hypertension later in life, thereby exacerbating the risk of cardiovascular diseases such as heart attacks and strokes.[7]In this regard, the present study aimedto estimate the prevalence of prehypertension and its risk factors among medical undergraduates

Study Design:it was an observational Cross-Sectional study.

Place of study: The study was conceived and undertaken under the guidance of faculty andstaff of the Department of Community Medicine, Rangaraya Medical College, Kakinada.

Study size: All 230 Second- and third-year Undergraduate Medical students who satisfied inclusion and exclusion criteria along with those who were willing to participate in this study, Rangaraya Medical College.

Inclusion criteria:

• Medical Students studying MBBS (Bachelor of Medicine & Bachelor of Surgery) in Rangaraya Medical College
• Clinically healthy
• Consent to participate in the study

Exclusion Criteria:

• Study subjects with known HTN/cardiovascular diseases
• Study Participants who are on antihypertensive or other cardiovascular drugs
• Study Participants Using any drugs that can affect BP

Study period

The study was carried out for 3 months from February   2022 to April 2022

Definition of Terms:

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) defines “Prehypertension” as systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg.[1]. 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.[8]. Physical Activity of 150 min per week or 30 min per day for 5 days a week is taken as adequate Physical activity according to CDC [9].Sleep:According to the National Sleep Foundation's guidelines, respondents were asked to report how much sleep they got each day, with the options being less than seven hours as inadequate or more than or equal to seven hours as adequate sleep.[10].

Study Tools:

A semi-structured pretested predesigned questionnaire was used to collect information regarding age, gender, type of diet, physical activity, sleep, habit of alcohol, smoking, Practice of yoga and family history of hypertension. Each student was subjected to anthropometric measurement of Height which was measured in centimetres with the help of a stadiometer to the nearest 1cm.Weight was measured with a bathroom weighing scale. The weighing Machine was regularly standardized with known standard weights. Measurements were taken to the nearest 100 grams. A Mercury sphygmomanometer was used to measure the blood pressure.

Data Collection:

The purpose of the study was explained to the students, written and verbal consent was taken and they were interviewed using a predesigned and pretested semi-structuredquestionnaire. Hypertension was defined as perJNC 7 guidelines and was measured using the auscultatory method with a standardized calibrated mercury column-type sphygmomanometer. An appropriately sized cuff encircling at least 80% of the arm in the seated posture, with feet on the floor and arm supported at heart level. After five minutes of rest after the class, blood pressure readings were recorded with a two-minute gap between each recording. Systolic blood pressure was measured at the time Korotkoff's sound was first perceived (Phase I), and diastolic blood pressure was measured at the time these noises disappeared (Phase V). the cuff was completely deflated between the readings. The average of the two readings was calculated and entered in the questionnaire.

Data analysis:

The data was double-checked and entered on Microsoft Excel-2019, and the final data analysis was done with the help of the statistical software SPSS 21. Continuous data was represented as mean and standard deviation, whereas categorical data was represented in proportions and frequencies. The data was tabulated and graphically represented.  The Pearson Chi-square test was used to assess the associations for categorical variables. Binary logistic regression analysis was performed using pre-HTN as dependent and other variables which were significantly associated with pre-HTN as independent variables.P < 0.05 considered significant. 

Ethical approval:

The study was approved by the Rangaraya Medical College Institutional Ethics Committee,Kakinada

A total of 230 Medical students from second- and third-year MBBS were participated in this study, out of which 131 were females and the rest 99 were males.  The overall prevalence of prehypertension among the whole group was 35.2 % as 81 of 230 students were prehypertensive while 149 (64.8%) were normotensive. The prevalence of prehypertension among boys and girls was almost similar 36/63 (36.4 %) vs 45/131 (34.4%)

The mean weight of the prehypertensive group of students was 62 ± 8.5 kg and was significantly higher than that of the normotensive group which was 55.06 ± 9.1 kg (P = 0.0007). Similarly, the mean body mass index of the prehypertensive group (23.28 ± 3.67) was significantly higher than of the normotensive group (21.16 ± 2.45) (P = 0.002). Prehypertension was more common in the overweight and obese groups (52.4% & 66.7%) than in the normal weight and underweight groups (4% & 28%), and the difference was determined to be statistically significant. (P < 0.0001)

Worldwide research has extensively examined hypertension as a known risk factor for cardiovascular accidents. A possible modifiable risk factor that comes before hypertension is called prehypertension. In a notable number of studies, it has been revealed that the prevalence of metabolic syndrome was higher among doctors worldwide than anticipated. The necessity to assess the risk factors for Prehypertension among medical students is crucial as they are future health care professionals.

The present study included 230 study participants with 99 male and 131 female students. This study confirms that the independent risk factors for prehypertension among the medical students were, Inadequate physical activity, sleep duration, BMI, Diet, Alcohol,smoking habits and Practice of Yoga.

In Present study, Prevalence of Pre-Hypertension was 35.2, similar findings was observed by Mishra etal[11] among medical students in medical college in Puducherry with Prevalence of Prehypertension was 38%.  A study on medical college students at Visakhapatnam with 275 participants conducted by Chitrapu RV [12] also observed similar findings with Prevalence of prehypertension was 37.4 %. Our study findings are contrast to the study conducted by Kulakarni MM on 100 medical students at Devnagari with Prehypertension prevalence was 64 %. Two studies [13,14]with higher prevalence of 52% and 58% conducted on 100 medical students and 150 girl medical students was observed. This higher prevalence in these studies compared to present study may be due to high proportion of overweight, obese category and could be variation in geographical, dietary and socio-economic factors.

In the present study, those who are not having adequate physical activity are 4.5 times greater risk (odds Ratio : 4.5 )of developing Pre-HTN ( P < 0.0001 ) similar findings were observed among male medical students in Chennai study (P <0.004 ) conducted by Logaraj, M., Madhavan, R. S. D., & Balaji, R [15] . Mithin Parmaron his  studyon Medical students at Rajsam and also observed that, prehypertension was more in the group with inadequate physical activity which supported our study findings[16].

In the current study, it was observed that those who were having inadequate sleep are four-fold increasedrisk (Odds ratio: 4)  of developing pre-HTN compared to those who had adequate sleep (P < 0.0001)

In this study, it was noticed that those who are on a mixed diet are at 4.5 times greater risk (Odds Ratio: 4.5) of developing Pre-HTN and was found to be significant ( P< 0.01 ) similar findings were observed by P.Likitha Bhavani  on his study on medical students in Andhra Pradesh were participants on mixed diet are 3.5 times higher risk of Prehypertension compared to vegetarian diet. [17]

In the present study, it was observed that those who are practising yoga are 4.5 times significantly lesser odds of being prone to Pre-HTN (P<0.01). it is obvious that Practicing yoga will relieve stress and relax mind and should encourage students to practice yoga and meditation. 

In this current study, those who had the habit of Alcohol were more than two-fold higher odds of risk of developing Pre-HTN ( P< 0.02 ) and those with a habit of Smokingare at 2.7 times higher risk of developing Pre-HTN.

Surprisingly this study did not find any significant increased odds of Risk for Pre HTN with gender (P <0.7 )  and Family history of Hypertension ( P< 0.4 ).

This study sheds light on the alarming prevalence of prehypertension among medical undergraduates. The findings indicate that a significant proportion of these individuals are at risk of developing hypertension later in life, and most of the risk factors are modifiable which emphasizes the need for the promotion of healthy lifestyles for prevention of Prehypertension. It is crucial to educate medical undergraduates about the potential health consequences of prehypertension and encourage them to adopt healthier lifestyles.

Acknowledgement:  The authors expressed their gratitude towards the medical students who actively participated in the study.

Funding: The study did not receive any financial support from external sources.

Conflict of interest: No conflicts of interest have been declared.

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