DOI 10.1515/ijamh-2013-0303 Int J Adolesc Med Health 2014; 26(2): 245–252
Supa Pengpid, Karl Peltzer* and Alice Joan G. Ferrer
Prehypertension and associated factors among university students in the Philippines Introduction
Abstract Background: Prehypertension is a new category of blood pressure, and is considered a cardiovascular risk factor. The aim of this study was to estimate the prevalence of prehypertension and its associated factors in young adults in the Philippines. Methods: Undergraduate university students from all areas of study in the University of the Philippines-Visayas were invited to participate. Prehypertension was defined as systolic blood pressure between 120 and 139 mm Hg and/or diastolic blood pressure between 80 and 89 mm Hg. Blood pressure, anthropometric, health behavior, and psycho social stress variables were measured. Results: A total of 754 university students were included in the analysis (mean age, 18.3 ± 1.4 years, 74.3% women). Prehypertension prevalence was 13.9% (36.1% in men, 6.8% in women), and hypertension prevalence was 2.4% (6.6% in men, 1.1% in women). The condition of prehypertension was associated with body mass index obesity (OR: 5.14, CI: 2.70 to 9.79), male gender (OR: 9.41, CI: 5.41 to 16.36), living off campus on their own (OR: 3.18, CI: 1.35 to 7.48), living with parents or guardians (OR: 2.83, CI: 1.20 to 6.60), and 19 years of age (OR: 2.81, CI: 1.55 to 5.11). Conclusion: One out of every 7 young adults presented with prehypertension. This condition is associated with established risk factors. Keywords: hypertension; prehypertension; risk factors; university students. *Corresponding author: Karl Peltzer, HIV/AIDS/SIT/and TB (HAST), Human Sciences Research Council, P/Bag X41, 0001 Pretoria, South Africa, E-mail: [email protected] Supa Pengpid and Karl Peltzer: ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand; and Department of Psychology, University of Limpopo, Sovenga, South Africa Alice Joan G. Ferrer: Division of Social Sciences, University of the Philippines-Visayas, Miag-ao, Iloilo, Philippines
Several studies have shown an increase in the prevalence of hypertension in high-, low-, and middle-income countries (1, 2). In addition, hypertension and prehypertension can start in adolescence (or earlier) and continue into adulthood (3). With modernization, the Philippines has experienced increasing rates of obesity and related cardiometabolic diseases (4). In a survey in the Philippines in 2008, age-adjusted hypertension prevalence was 24.6% at a single visit and 20.6% when corrected for true prevalence; in addition, the prevalence of smoking was 31%, obesity was 4.9% by body mass index (BMI), and 10.2% and 65.6% by waist-hip ratio (WHR) in men and women, respectively (5). Currently, there are few studies on the assessment of prehypertension and hypertension in young adults in the Philippines. In addition, hypertension and prehypertension are asymptomatic. Hence, it is very important to diagnose elevated blood pressure (preHTN and HTN) at an early age. The prevalence of prehypertension among university students in different countries was found in Saudi Arabian females (13.5%) (6), Libya 27.1% (38% males, 11.2% females) (7), Malaysia 42.9% (8), and Kuwait 39.5% (9). Among Indian medical students, 67% had prehypertension and hypertension (10), and the prevalence of hypertension ranged from 2.2% in Libya (7), 7% in Argentina (11) and Kuwait (9), 12.8% in Chile (12) and Malaysia (8), and 6.9% to 24.9% in Portugal (13, 14). Factors associated with prehypertension or hypertension among university students included sociodemographics [male gender (9, 11, 12, 14), greater age (11) and hypertensive first-degree relatives (14)], BMI obesity (6, 7, 9, 11, 15–18), substance use [smoking (7, 9) and heavy alcohol use (19)], and in young women taking oral contraceptives (14). In addition, among general adults, factors associated with prehypertension or hypertension included physical inactivity (20, 21), excess sodium intake (20), inadequate fruit and vegetable consumption (FVC) (20), psychosocial stress [posttraumatic stress disorder (PTSD) (22), depression (23) and short sleep duration (24, 25)], and poor sleep quality (25). Additional risk factors not assessed in this study included the dyslipidemias, an early family history
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246 Pengpid et al.: Prehypertension among university students in the Philippines of cardiovascular disease, hyperinsulinemia and insulin resistance, impaired fasting glucose, a prothrombic state, endothelial dysfunction, and impaired vascular distensibility (20). The purpose of the current study was to evaluate the prevalence of prehypertension and hypertension as well as to identify the risk factors for prehypertension based on a cross-sectional survey of a university undergraduate population in the Philippines.
Materials and methods
tween 120 and 139 mm Hg and/or diastolic blood pressure between 80 and 89 mm Hg (26).
Height (without footwear) Weight (without footwear and any heavy accessories) was measured using a stadiometer and calibrated weighing scale. BMI was calculated as weight in kg divided by height in meter squared. According to new Asian BMI classifications BMI ≥ 23 and ≥ 25 kg/m2 were classified as overweight and obesity, respectively (27). These cutoff points can be used at early stages to identify risk factors of chronic diseases such as cardiovasculardisease and diabetes mellitus (28).
Sample and procedure
Physical activity
The sample included 782 undergraduate university (754 with blood pressure measurements) students from the three campuses of the University of the Philippines-Visayas (in Miagao, Iloilo Province; Iloilo City; and Tacloban City, Leyte Province). Of this number, 543 (69%) were from 20 classes of 15 faculty members from the College of Arts and Sciences, College of Management, and Tacloban College. The rest of the students (239, 31%) were walk-in students who volunteered to participate in the survey. Data were collected by a self-administered questionnaire in a classroom situation after informed consent was obtained from the participants. In addition, anthroprometric measurement and blood pressure were taken. Permission to carry out the study was obtained from the Chancellor of the University and ethical clearance was also taken from the Ethics Committee of the Western Visayas Health Research and Development Consortium as well as the University of Limpopo. The cover page of the questionnaire briefly explained the objectives of the study and provided instructions to the respondents on how to answer the questions appropriately. It provided information about the researchers and informed the participants that anonymity and confidentiality would be maintained, and that the participation of students was voluntary. The cover page also specified that data would be used only for research purposes. The study was conducted from January 2013 to February 2013.
This was assessed using the International Physical Activity Questionnaire (IPAQ) short version, self-administered last 7 days (IPAQ-S7S). We used the instructions given in the IPAQ manual for reliability and validity, which was detailed elsewhere (29). The major goal of the IPAQ instruments is to sum up the single indicators to an overall indicator of PA-related EE (Metabolic equivalent, MET min -1). We used the following recommended MET estimates of IPAQ: Vigorous PA = 8 METs, moderate PA = 4 METs, walking on average = 3.3 METs. For calculating the overall MET PA, each category was multiplied with its special MET estimate value. We also used the recommended categorical score, three levels of PA (low, moderate, and high) as proposed in the IPAQ Scoring Protocol (short form). Low activity represented individuals who do not meet the criteria for moderate and vigorous intensity categories (
Supa Pengpid, Karl Peltzer* and Alice Joan G. Ferrer
Prehypertension and associated factors among university students in the Philippines Introduction
Abstract Background: Prehypertension is a new category of blood pressure, and is considered a cardiovascular risk factor. The aim of this study was to estimate the prevalence of prehypertension and its associated factors in young adults in the Philippines. Methods: Undergraduate university students from all areas of study in the University of the Philippines-Visayas were invited to participate. Prehypertension was defined as systolic blood pressure between 120 and 139 mm Hg and/or diastolic blood pressure between 80 and 89 mm Hg. Blood pressure, anthropometric, health behavior, and psycho social stress variables were measured. Results: A total of 754 university students were included in the analysis (mean age, 18.3 ± 1.4 years, 74.3% women). Prehypertension prevalence was 13.9% (36.1% in men, 6.8% in women), and hypertension prevalence was 2.4% (6.6% in men, 1.1% in women). The condition of prehypertension was associated with body mass index obesity (OR: 5.14, CI: 2.70 to 9.79), male gender (OR: 9.41, CI: 5.41 to 16.36), living off campus on their own (OR: 3.18, CI: 1.35 to 7.48), living with parents or guardians (OR: 2.83, CI: 1.20 to 6.60), and 19 years of age (OR: 2.81, CI: 1.55 to 5.11). Conclusion: One out of every 7 young adults presented with prehypertension. This condition is associated with established risk factors. Keywords: hypertension; prehypertension; risk factors; university students. *Corresponding author: Karl Peltzer, HIV/AIDS/SIT/and TB (HAST), Human Sciences Research Council, P/Bag X41, 0001 Pretoria, South Africa, E-mail: [email protected] Supa Pengpid and Karl Peltzer: ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand; and Department of Psychology, University of Limpopo, Sovenga, South Africa Alice Joan G. Ferrer: Division of Social Sciences, University of the Philippines-Visayas, Miag-ao, Iloilo, Philippines
Several studies have shown an increase in the prevalence of hypertension in high-, low-, and middle-income countries (1, 2). In addition, hypertension and prehypertension can start in adolescence (or earlier) and continue into adulthood (3). With modernization, the Philippines has experienced increasing rates of obesity and related cardiometabolic diseases (4). In a survey in the Philippines in 2008, age-adjusted hypertension prevalence was 24.6% at a single visit and 20.6% when corrected for true prevalence; in addition, the prevalence of smoking was 31%, obesity was 4.9% by body mass index (BMI), and 10.2% and 65.6% by waist-hip ratio (WHR) in men and women, respectively (5). Currently, there are few studies on the assessment of prehypertension and hypertension in young adults in the Philippines. In addition, hypertension and prehypertension are asymptomatic. Hence, it is very important to diagnose elevated blood pressure (preHTN and HTN) at an early age. The prevalence of prehypertension among university students in different countries was found in Saudi Arabian females (13.5%) (6), Libya 27.1% (38% males, 11.2% females) (7), Malaysia 42.9% (8), and Kuwait 39.5% (9). Among Indian medical students, 67% had prehypertension and hypertension (10), and the prevalence of hypertension ranged from 2.2% in Libya (7), 7% in Argentina (11) and Kuwait (9), 12.8% in Chile (12) and Malaysia (8), and 6.9% to 24.9% in Portugal (13, 14). Factors associated with prehypertension or hypertension among university students included sociodemographics [male gender (9, 11, 12, 14), greater age (11) and hypertensive first-degree relatives (14)], BMI obesity (6, 7, 9, 11, 15–18), substance use [smoking (7, 9) and heavy alcohol use (19)], and in young women taking oral contraceptives (14). In addition, among general adults, factors associated with prehypertension or hypertension included physical inactivity (20, 21), excess sodium intake (20), inadequate fruit and vegetable consumption (FVC) (20), psychosocial stress [posttraumatic stress disorder (PTSD) (22), depression (23) and short sleep duration (24, 25)], and poor sleep quality (25). Additional risk factors not assessed in this study included the dyslipidemias, an early family history
Brought to you by | Western University Authenticated Download Date | 6/10/15 12:25 AM
246 Pengpid et al.: Prehypertension among university students in the Philippines of cardiovascular disease, hyperinsulinemia and insulin resistance, impaired fasting glucose, a prothrombic state, endothelial dysfunction, and impaired vascular distensibility (20). The purpose of the current study was to evaluate the prevalence of prehypertension and hypertension as well as to identify the risk factors for prehypertension based on a cross-sectional survey of a university undergraduate population in the Philippines.
Materials and methods
tween 120 and 139 mm Hg and/or diastolic blood pressure between 80 and 89 mm Hg (26).
Height (without footwear) Weight (without footwear and any heavy accessories) was measured using a stadiometer and calibrated weighing scale. BMI was calculated as weight in kg divided by height in meter squared. According to new Asian BMI classifications BMI ≥ 23 and ≥ 25 kg/m2 were classified as overweight and obesity, respectively (27). These cutoff points can be used at early stages to identify risk factors of chronic diseases such as cardiovasculardisease and diabetes mellitus (28).
Sample and procedure
Physical activity
The sample included 782 undergraduate university (754 with blood pressure measurements) students from the three campuses of the University of the Philippines-Visayas (in Miagao, Iloilo Province; Iloilo City; and Tacloban City, Leyte Province). Of this number, 543 (69%) were from 20 classes of 15 faculty members from the College of Arts and Sciences, College of Management, and Tacloban College. The rest of the students (239, 31%) were walk-in students who volunteered to participate in the survey. Data were collected by a self-administered questionnaire in a classroom situation after informed consent was obtained from the participants. In addition, anthroprometric measurement and blood pressure were taken. Permission to carry out the study was obtained from the Chancellor of the University and ethical clearance was also taken from the Ethics Committee of the Western Visayas Health Research and Development Consortium as well as the University of Limpopo. The cover page of the questionnaire briefly explained the objectives of the study and provided instructions to the respondents on how to answer the questions appropriately. It provided information about the researchers and informed the participants that anonymity and confidentiality would be maintained, and that the participation of students was voluntary. The cover page also specified that data would be used only for research purposes. The study was conducted from January 2013 to February 2013.
This was assessed using the International Physical Activity Questionnaire (IPAQ) short version, self-administered last 7 days (IPAQ-S7S). We used the instructions given in the IPAQ manual for reliability and validity, which was detailed elsewhere (29). The major goal of the IPAQ instruments is to sum up the single indicators to an overall indicator of PA-related EE (Metabolic equivalent, MET min -1). We used the following recommended MET estimates of IPAQ: Vigorous PA = 8 METs, moderate PA = 4 METs, walking on average = 3.3 METs. For calculating the overall MET PA, each category was multiplied with its special MET estimate value. We also used the recommended categorical score, three levels of PA (low, moderate, and high) as proposed in the IPAQ Scoring Protocol (short form). Low activity represented individuals who do not meet the criteria for moderate and vigorous intensity categories (
