Prevalence and risk factors of prehypertension in university students in Sabah, Borneo Island of East Malaysia

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Abstract

Unhealthy lifestyle contributes mainly to an increased prevalence of non-communicable diseases including hypertension and cardiovascular diseases tend to increase in Malaysia. These diseases lead to an increased risk of end organ damage and cardiovascular complications. In this study, the prevalence of prehypertension and its associated risk factors among a cohort of university students in Sabah was determined.

This is a prospective, cross-sectional study conducted among 365 undergraduate students irrespective of faculties at Universiti Malaysia Sabah (UMS). Standardized and validated World Health Organization (WHO) STEPS questionnaires were used to collect sociodemographic data. Additionally, clinical and anthropometric data were measured and recorded by a trained staff, followed by descriptive and logistic regression analyses.

A total of 365 UMS undergraduate students aged 18 years and above participated in the study. The prevalence of prehypertension among university students was high (31%) (95% CI [29.1%, 34.3%]). Well-known risk factors for hypertension including family history of hypertension, reduced sleep duration, reduced physical activity, smoking, being overweight or obese were significantly associated with the risk of developing prehypertension ( P < .05) among UMS students. However, no association was observed between ethnicity, age, and gender with prehypertension.

A worryingly high percentage of UMS students are prehypertensive, indicating the need of early preventive strategies aimed at increasing awareness, early screening, and lifestyle modification to reduce the rising burden of the disease and the associated complications in this age group.

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Most cited references 27

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The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

Aram V Chobanian, George L Bakris, Henry R Black … (2003)

"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.

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A risk score for predicting near-term incidence of hypertension: the Framingham Heart Study.

Katherine J. Lanier, B D’Agostino, W Kannel … (2008)

Studies suggest that targeting high-risk, nonhypertensive individuals for treatment may delay hypertension onset, thereby possibly mitigating vascular complications. Risk stratification may facilitate cost-effective approaches to management. To develop a simple risk score for predicting hypertension incidence by using measures readily obtained in the physician's office. Longitudinal cohort study. Framingham Heart Study, Framingham, Massachusetts. 1717 nonhypertensive white individuals 20 to 69 years of age (mean age, 42 years; 54% women), without diabetes and with both parents in the original cohort of the Framingham Heart Study, contributed 5814 person-examinations. Scores were developed for predicting the 1-, 2-, and 4-year risk for new-onset hypertension, and performance characteristics of the prediction algorithm were assessed by using calibration and discrimination measures. Parental hypertension was ascertained from examinations of the original cohort of the Framingham Heart Study. During follow-up (median time over all person-examinations, 3.8 years), 796 persons (52% women) developed new-onset hypertension. In multivariable analyses, age, sex, systolic and diastolic blood pressure, body mass index, parental hypertension, and cigarette smoking were significant predictors of hypertension. According to the risk score based on these factors, the 4-year risk for incident hypertension was classified as low ( 10%) in 47%. The c-statistic for the prediction model was 0.788, and calibration was very good. The risk score findings may not be generalizable to persons of nonwhite race or ethnicity or to persons with diabetes. The risk score algorithm has not been validated in an independent cohort and is based on single measurements of risk factors and blood pressure. The hypertension risk prediction score can be used to estimate an individual's absolute risk for hypertension on short-term follow-up, and it represents a simple, office-based tool that may facilitate management of high-risk individuals with prehypertension.

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Poor sleep quality and resistant hypertension.

Agostino Virdis, Laura Palagini, Lorenzo Ghiadoni … (2013)

We aimed to determine the relationship between sleep quality and treatment-resistant hypertension (RH). In our cross-sectional cohort study, 270 consecutive essential hypertensive patients were recruited at the Outpatient Hypertension Unit, University of Pisa, Italy. The Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI-Y2) were administered to all subjects. RH was defined as office blood pressure (BP) >140/90 mmHg with three or more antihypertensive drugs or controlled BP with four or more drugs. Poor sleep quality was defined as PSQI >5, depressive symptoms as BDI >10, and trait anxiety as STAI-Y2 >40. Patients with other sleep disorders were excluded. Complete data were available for 222 patients (50.9% men; mean age, 56.6±12.5 y; RH, 14.9%). Poor sleep quality had a prevalence of 38.2% in the overall population. RH was associated with poor sleep quality, increased sleep latency and reduced sleep efficiency. No significant relationship was found between RH and short sleep duration or depressive symptoms and trait anxiety. Poor sleep quality was more prevalent in resistant vs nonresistant hypertensive women (70.6% vs 40.2%; P=.02) but not in resistant vs nonresistant men (43.8% vs 29.2%; P=.24). In women poor sleep quality was an independent predictor of RH, even after adjustment for cardiovascular and psychiatric comorbidities (odds ratio [OR], 5.3 [confidence interval {CI}, 1.1-27.6), explaining 4.7% of its variance. In men age, diabetes mellitus (DM), and obesity were the only variables associated with RH. Poor sleep quality is significantly associated with resistance to treatment in hypertensive women, independent of cardiovascular and psychiatric confounders. Copyright © 2013 Elsevier B.V. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: May 2020

Publication date (Electronic): 22 May 2020

Volume: 99

Issue: 21

Electronic Location Identifier: e20287

Affiliations

[a ]Department of Community and Family Medicine, Faculty of Medicine and Health Science

[b ]Sabah Borneo Medical and Health Research Centre, Universiti Malaysia Sabah, Kota Kinabalu, Sabah

[c ]School of Pharmacy, Monash University Malaysia, Selangor Darul Ehsan

[d ]Department of Biomedical Science and Therapeutics, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia

[e ]FAST School of Management, National University of Computer and Emerging Sciences, Karachi, Pakistan.

Author notes

[∗ ]Correspondence: Mohd Nazri Mohd Daud, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia (e-mail: mohd.nazri@ 123456ums.edu.my ).

Article

Publisher ID: MD-D-19-08490 Accession ID: 20287

DOI: 10.1097/MD.0000000000020287

PMC ID: 7250021

PubMed ID: 32481309

SO-VID: 3a7501c3-887b-4265-87b8-9a930e8d23f3

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

History

Date received : 29 October 2019

Date revision received : 24 March 2020

Date accepted : 15 April 2020

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Keywords: associated risk factors,malaysian students,prehypertension,prevalence,undergraduate

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Keywords: associated risk factors, malaysian students, prehypertension, prevalence, undergraduate

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Prevalence and risk factors of prehypertension in university students in Sabah, Borneo Island of East Malaysia

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Most cited references 27

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

A risk score for predicting near-term incidence of hypertension: the Framingham Heart Study.

Poor sleep quality and resistant hypertension.

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