Introduction was considered as normal blood pressure


Hypertension is
one of the major risk factors for global mortality and is estimated to have
caused 9.4 million deaths, according to the WHO Global Status Report on
Non-communicable Diseases in 2014 1. 

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The National High Blood Pressure
Education Program Coordinating Committee of the National Heart, Lung, and Blood
Institute in United States released the Seventh Report of the Joint National
Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (the JNC 7 report), on May 14th, 2003 2.
According to this report, a systolic blood pressure (SBP) less than 120 mm Hg
and diastolic blood pressure (DBP) less than 80 mm Hg was considered as normal
blood pressure and a systolic BP of 120 to 139 mm Hg and/or a diastolic BP of
80 to 89 mm Hg was considered as pre-hypertension. The definition of
pre-hypertension remains the same in the latest JNC-8 report published in 2014 3.The
objective of defining this classification of blood pressure was to draw the
attention of clinicians and public in the prevention of hypertension in healthy
people in the pre-hypertensive range of blood pressure. Various studies
conducted in India have shown the prevalence of pre-hypertension in the age
group 20–30 years to be ranging from 24.6 to 65% 4-9.Although pre-hypertension is an asymptomatic condition, it
chronically evolves into a major risk factor for cardiovascular,
cerebrovascular, and renal diseases that, in turn, represent crucial causes of
morbidity and mortality.

Stress can cause hypertension through repeated blood pressure
elevations as well as by stimulation of the nervous system to produce large
amounts of vasoconstricting hormones that increase blood pressure. In
these days, stress has become a
prevalent part of people’s lives in very early stage of life; therefore the
effect of stress on blood pressure is of
increasing relevance and importance in young adults.


Primary Objective:

To find prevalence of pre-hypertension among University Students
(18-30 years).

Secondary Objective:

To find out association between pre-hypertension and stress
among University Students (18-30 years).



Study design:
Cross sectional study.


period: Two months (April-May 2018).


population: University Students of Central India (18-30 years).


Sample size: Sample size has been estimated by
OpenEpi software Version 3 using following assumptions-

sided significance level (1-alpha): 95%

estimated sample size is 200. 


Sampling strategy: University
students (Undergraduate, Postgraduate, and PhD) from different colleges of
Central India (18-30 years) will be potential participants of the study.                              We will offer participation till
desired number of participants is recruited.

Criteria: University Students
between 18-30 years (Undergraduate, Postgraduate and PhD).

Criteria: Known hypertensive (both primary and secondary) already on
treatment for hypertension and those not consenting for voluntary participation.

Data collection: Data will be collected by individually
interviewing the participant maintaining confidentiality and privacy. A
structured questionnaire will be prepared. Questionnaire will have socio demographic
variables, blood pressure readings, perceived stress scale. We will be using
the 10 point Perceived Stress Scale that has already been extensively used and
validated in India.



Operational definitions:

Pre Hypertension:  Systolic Blood Pressure of 120 to 139 mm Hg and/or
a diastolic Blood Pressure of 80 to 89 mm Hg is considered as pre-hypertension 10.
Stress: Psychological stress has been defined
as the extent to which persons perceive (appraise) that their demands
exceed their ability to cope.


Measurement Tools:

1.     A
pre-tested questionnaire will be administered to the subjects after obtaining
their consent. The questionnaire will comprise socio demographic variables like
name, age, gender, profession, category of study, marital status, whether
living with family or not and family history of hypertension and psychiatric

2.     Three
consecutive measurements of systolic and diastolic blood pressure will be
measured by appropriately sized cuff and the bell of a standard stethoscope,
with at least 1 min between assessments after the participant has rested
for 5 min in a sitting position. Average blood pressure will be calculated
arithmetically for the 3 measurements of each systolic and diastolic blood
pressure. Missing values will be excluded from being included in the study. Blood
pressure classification will be done using JNC 7 algorithm 11. Pre hypertension is defined as
systolic blood pressure (SBP) measurement of 120–139?mmHg or diastolic blood
pressure (DBP) of 80–89?mmHg in people who are not taking antihypertensive
medication. Hypertension is defined as SBP ?140 mmHg and/or DBP
?90 mmHg and/or current use of antihypertensive medication. Normotension
is defined as BP values <120/80 mmHg in students who are not taking antihypertensive medication 12. All respondents will be asked if they have ever been diagnosed with hypertension and if they did, whether or not they have been taking any kind of drugs or other treatment for the last 2 weeks and last 12 months. 3.     10 point Perceived Stress Scale will be used which has already been extensively used and validated in India. The Perceived Stress Scale (PSS) is a classic stress assessment instrument. The tool, while originally developed in 1983, remains a popular choice for helping understand how different situations affect feelings and perceived stress. The questions in this scale ask about the feelings and thoughts during the last month. In each case, they will be asked to indicate how often they felt or thought a certain way. 4.     For each item 0=never; 1=almost never; 2=sometimes; 3=fairly often; 4=very often Interpretation will be done as follows: First, reversing the scores for questions 4, 5, 7, and 8. On these 4 questions, the score will be changed as- 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0. Addition of the scores for each item will be done to get a total. Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress. ?Scores ranging from 0-13 would be considered low stress. ?Scores ranging from 14-26 would be considered moderate stress. ?Scores ranging from 27-40 would be considered high perceived stress.   Plan of analysis: Analysis will be done using Epi-info software. Descriptive analysis using frequency and proportion will be carried out. Odds ratio with 95% confidence intervals will be estimated for studying associations.   Ethical considerations: This study will be initiated only after approval from the institutional ethical committee. A written informed consent will be taken from the Young Adults participating in this study. The young adults detected with pre-hypertension will be referred to the physician for counseling and treatment. Those found with high scores of stress will also be counseled regarding management of stress. Implications Pre-hypertension elevates the risk of Cardiovascular Diseases, and that of end-stage renal disease. Cardiovascular morbidities are increasing among pre-hypertensive individuals compared to normal. Pre-hypertension may also be associated with on-going Cardiovascular changes. It is necessary to screen the pre-hypertensive individuals in early age so as to prevent them from progressing towards full blown hypertension. As pre hypertensive stage is asymptomatic, there should be screening strategies for pre-hypertension at an early age and National programs should be initiated for Young Adults in the country. This study will also focus on counseling for psychological stress management and lifestyle modification which can help to prevent significant mortalities and morbidities among the Youth. It is necessary to identify risks associated with pre-hypertension in young adults, and improving our prevention strategies at both the individual and population levels. Given the high incidence of stress and pre-hypertension among Young Adults, this intervention may have the potential to result in substantial savings for the nation.