Abstract
IMPORTANCE High blood pressure (BP) in children and adolescents is becoming one of the most common health conditions worldwide and is much more widely prevalent than previously thought. OBJECTIVE To estimate the prevalence of high BP in adolescents in India and identify associated factors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study is a secondary analysis of data from the Comprehensive National Nutrition Survey (CNNS, 2016-2018), which used a multistage, stratified, probability proportion to size cluster sampling design to enroll a nationally representative sample of households and individuals aged 10 to 19 years across all states and union territories of India. Adolescents with acute or chronic illness, physical deformity, mental illness, or cognitive disability were excluded from the survey. Because BP was measured only in children between 10 and 19 years of age, only data from children within this age group were included for secondary analyses. Data analysis was performed from March 2021 to April 2022. EXPOSURES Anthropometry. MAIN OUTCOMES AND MEASURES On the basis of the 2017 American Academy of Pediatrics guidelines, high BP was defined as stage 1 and 2 hypertension, with BP above the 95th percentile in children younger than 13 years and greater than 130/80 mm Hg in children 13 years or older. The association of age, sex, region, socioeconomic status, body mass index, fasting blood glucose, hemoglobin A1c, and lipid profile with high BP were examined using log binomial regression. RESULTS Among 16 182 eligible children aged 10 to 19 years (mean [SD] age, 14.2 [2.8] years; 7849 [48.5%] female and 8333 [51.5%] male), 11718 had valid BP data with 3 repeated readings. the prevalence of high BP was 35.1% (95% CI, 31.5%-38.9%) in children aged 10 to 12 years and 25.1% (95% CI, 22.5%-28.0%) in children 13 years or older. Overweight and obesity were associated with a higher risk of high BP in both younger (prevalence ratio, 1.17; 95% CI, 1.04-1.34) and older children (prevalence ratio, 1.33; 95% CI, 1.18-1.49). The prevalence of high BP in younger children with stunting was high at 40.1% (95% CI, 31.9%-48.9%) and was 21.9% (95% CI, 18.2%-26.1%) among older children with stunting. In both age groups, high BP coexisted with other cardiovascular disease risk factors, such that adolescents with high fasting blood glucose, high hemoglobin A1c, high triglyceride, and high low-density lipoprotein cholesterol levels had a higher risk of high BP. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the prevalence of high BP, along with cardiovascular risk factors, was substantial in Indian adolescents. There is a need to screen and identify adolescents who have high BP and initiate interventions to control the burden of hypertension and its consequences in India.
Generated Summary
This cross-sectional study is a secondary analysis of data from the Comprehensive National Nutrition Survey (CNNS, 2016-2018), which enrolled a nationally representative sample of adolescents aged 10 to 19 years across India. The study aimed to estimate the prevalence of high blood pressure (BP) in Indian adolescents and identify associated factors. Data analysis was performed from March 2021 to April 2022. High BP was defined based on the 2017 American Academy of Pediatrics guidelines. The associations of sociodemographic factors, anthropometric measures, and cardiometabolic risk factors with high BP were examined using log binomial regression. The study provides insights into the prevalence and associated risk factors of high BP among adolescents in India, offering valuable information for public health interventions.
Key Findings & Statistics
- Among 16,182 eligible children aged 10 to 19 years (mean [SD] age, 14.2 [2.8] years; 7849 [48.5%] female and 8333 [51.5%] male), 11,718 had valid BP data with 3 repeated readings.
- The prevalence of high BP was 35.1% (95% CI, 31.5%-38.9%) in children aged 10 to 12 years and 25.1% (95% CI, 22.5%-28.0%) in children 13 years or older.
- The statewide prevalence of high BP varied.
- In the younger group, children in the richest wealth category had a lower prevalence of high BP (PR, 0.82; 95% CI, 0.70-0.96) compared with children from the poorest wealth category. This difference was not observed in the older group.
- The mean SBP and DBP was higher by almost 2 mm Hg in older compared with younger children (Table 1).
- The SBP was lower in girls by 2.0 mm Hg (95% CI, 1.5-2.5 mm Hg) compared with boys in the older age group.
- The prevalence of stunting was 24.8% in the younger age group and 27.0% in the older age group. The prevalence of underweight was 23.0% in the younger children and 17.0% in the older children. The prevalence of overweight was 5.8% and the prevalence of obesity was 1.5% in both age groups.
- Children aged 10-12 years: Normal – 48.9 (44.5-53.3), Elevated – 15.9 (13.8-18.4), Stage 1 hypertension – 28.7 (25.3-32.4), Stage 2 hypertension – 6.4 (4.9-8.4), High blood pressure (stage 1 and 2 hypertension) – 35.1 (31.5-38.9)
- Children aged ≥13 years: Normal – 64.1 (61.2-66.8), Elevated – 10.8 (9.4-12.4), Stage 1 hypertension – 20.2 (18.1-22.6), Stage 2 hypertension – 4.9 (3.3-7.2), High blood pressure (stage 1 and 2 hypertension) – 25.1 (22.5-28.0)
- In the younger group, the prevalence of high BP was higher in children with overweight or obesity (PR, 1.17; 95% CI, 1.04-1.34).
- The increased prevalence was 17% in the younger group and 32% in the older group (PR, 1.32; 95% CI, 1.18-1.49).
- The prevalence of high BP was also high among children with underweight (BMI for age z score less than -2) in both age groups (32.2% for younger children and 21.5% for older children).
- The prevalence of high BP in children with high fasting blood glucose levels was 46.4% compared with 35.0% in those with normal blood glucose levels among the younger children (Table 3).
Other Important Findings
- Overweight and obesity were associated with a higher risk of high BP in both younger and older children.
- In both age groups, high BP coexisted with other cardiovascular disease risk factors.
- Adolescents with high fasting blood glucose, high hemoglobin A1c, high triglyceride, and high low-density lipoprotein cholesterol levels had a higher risk of high BP.
- The prevalence of high BP in rural areas was as high as that in urban areas.
- The association of overweight and obesity with high BP was further examined within stratified samples of children with and without stunting.
- High BP was found to coexist with other cardiovascular disease risk factors.
Limitations Noted in the Document
- The reported estimates for high BP are based on 1 visit, using an undocumented oscillometric device for BP measurement.
- Because this is a cross-sectional survey, causality cannot be inferred.
- The prevalence of overweight and obesity, which is positively associated with high BP, was 3% higher in the analyzed sample compared with those not considered for analysis because of the missing BP measurements, which could have slightly overestimated the prevalence.
- Data on some potential factors associated with hypertension, such as prematurity, birth weight, nutrition-related factors, and physical activity, were not available for exploration.
- The details of exclusion from sampling for BP measurements are not available from the original study.
Conclusion
In this cross-sectional study, the prevalence of high BP among Indian adolescents was substantial, particularly in the younger age group, and was associated with overweight/obesity and other cardiovascular risk factors. The findings suggest that the prevalence of high BP in Indian adolescents is substantial and coexists with other cardiovascular disease risk factors. The study indicates that there is a need to screen and identify adolescents who have high BP and initiate interventions to control the burden of hypertension and its consequences in India. The study’s findings align with the growing global concern regarding the increasing prevalence of high BP in children and adolescents, emphasizing the need for early detection and intervention. This is particularly crucial given the established link between high BP in childhood and cardiovascular morbidity and mortality in adulthood. The study highlights the importance of addressing the double burden of malnutrition, where undernourished children may paradoxically experience metabolic obesity and, consequently, high BP. The coexistence of high BP with other cardiovascular risk factors, such as high fasting blood glucose, elevated triglycerides, and high LDL-C levels, underscores the need for comprehensive approaches to cardiovascular health in this population. The study’s observation of high BP in both rural and urban areas indicates that the issue is widespread and requires attention across diverse socioeconomic settings. The study also notes that the results noted here is similar to the high prevalence of hypertension reported in Indian adults. Given the high prevalence of high BP among adolescents in India, the findings warrant urgent attention toward the implementation of screening programs and public health policies aimed at mitigating the long-term consequences of hypertension. Addressing this issue early on is essential to prevent the development of cardiovascular diseases in adulthood and to promote overall health and well-being in the population.