Research Paper Volume : 4 | Issue : 1 | January 2015 • ISSN No 2277 - 8179 BIOLOGY Prevalence of hypertension among KEYWORDS : Blood Pressure, Over- boys (6-18 years) belonging to weight, Hypertension, Tripuri tribe Tripuri tribal of Tripura Sandeep Roy Sarkar Department of Human Physiology, Tripura University, Tripura, India Samir Kumar Sil Department of Human Physiology, Tripura University ,Tripura, India ABSTRACT The present study was undertaken to evaluate the prevalence of sustained hypertension and prehypertension and to determine the relationship between body mass index (BMI), waist circumference (WC) and blood pressure among rural Tripuri tribal boys of Tripura. This cross-sectional study was performed involving 458 healthy boys aged 6 to 18 years from rural areas of Mohanpur and Jampuijala sub-divisions of West Tripura district, Tripura. Systolic and diastolic blood pressure was measured by ausculta- tory method using a mercury sphygmomanometer and stethoscope. Prevalence of overweight was observed 1.53% by using BMI as indicator. No trend of obesity was recorded. Systolic blood pressure and Diastolic blood pressure was progressively accelerated as the age advances with few fluctuations. The prevalence of prehypertension and hypertension combining all ages was found to be 9.39% and 2.62% respectively among rural Tripuri tribal boys. Positive correlations were observed between blood pressure, BMI and waist circumference. INTRODUCTION tension and cardiovascular disease was recorded. Family history Hypertension is a major public health problem worldwide and was taken to be a history of hypertension in the parents or the is one of the risk factors for coronary artery disease and cer- grandparents. ebrovascular disease. Development of adult hypertension may start very early in life, and children maintain their position in Anthropometric measurements were taken following the pro- the blood pressure distribution over time (Shear et al., 1986). tocol of International Biological Programme (Weiner and Lou- As the symptoms of childhood hypertension are largely nonspe- rie, 1969). Body weight was recorded to the nearest 0.5 kg with cific, most children with essential hypertension are likely to be the subject standing motionless on a personal weighing scale. asymptomatic (Tanne, 2002). The long-term health risks for hy- Height was measured to the nearest 0.1 cm with the help of an pertensive children and adolescents can be substantial; there- anthropometer. Waist circumference was measured with the fore, it is important that clinical measures be taken to reduce subject in the standing position. BMI (kg/m2) was also calculat- these risks and optimize health outcomes. ed. Participants were asked to remove their shows and to wear light underwear prior to taking measurements. Before blood Overweight, obesity and hypertension are significant risk factors pressure measurements, students were familiarized to the in- for increased morbidity and mortality, not only in high-income strument and the nature of the procedure was explained. Blood but also in developing countries like India. Thus, assessing the pressure was determined by auscultation in right arm after a prevalence of overweight, obesity and hypertension in children minimum rest of 30 minutes, by standardized method using and adolescents may predict the future health of a country’s the mercury sphygmomanometer (NIH, 2005). For each student, population ( Bao et al., 1995). Although there have been steady the blood pressure was measured thrice in the same visit with increases in the prevalence of these parameters among the Indi- a minimum of 30 seconds rest between each determination and an population (Gupta, 2004; Deshmukh et al., 2006) there exists mean blood pressure was calculated. The systolic blood pressure limited data on such issues among different populations of our was determined by the onset of the “tapping” Korotkoff-1 sound country (Deshmukh et al., 2006; Gupta et al., 2007). and the diastolic at its disappearance (Korotkoff-5). Students found to have hypertension or prehypertension on first visit Tripuri tribes are considered to be a part of the Tibeto-Burmese were undergo a second set of blood pressure measurements at ethnic group and physically they exhibit mongoloid features least four weeks later after the first measurement. The standard (DevBarman, 2004). Very few studies on growth have been re- (NIH, 2005) norms were then used to conclude the presence or ported on the Tripuris, the numerically major tribal population absence of hypertension or prehypertension. All anthropometric of Tripura (Sarkar et al., 2012; Sil et al., 2012; Sarkar and Sil, and blood pressure measurements were made by a single ob- 2014), but studies relating hypertension are rare. Therefore this server, the first author himself. study was undertaken to determine the prevalence of sustained hypertension and prehypertension and also to determine the re- RESULTS lationship between body mass index (BMI), waist circumference The analytical results for the distribution of two anthropometric and blood pressure among apparently healthy school children variables of rural Tripuri boys according to ages are represented residing in Tripura, north-eastern India. in Table 1. Mean values of all anthropometric variables are pro- gressively accelerating with advancement of age with few fluc- METHODOLOGY tuations. The BMI cut-offs for overweight and obesity was >23.0 This cross-sectional, school-based survey was carried out from and >25.0 kg/m2 respectively (WHO, 2000) The prevalence of May to November 2012. The study was in accordance with the overweight was observed 1.53% among rural Tripuri tribal boys Helsinki Declaration of 1964, as revised in 2000 (Touitou, 2004). of Tripura. No prevalence of obesity was observed. Childrens of aged 6-18 years were enrolled from rural localities of Abhicharan and Kamalghat (under Mohanpur sub-division), Mean and Standard Deviation (SD) of Systolic blood pressure Takarjala, and Gabordi (under Jampuijala sub-division) of West (SBP) and Diastolic blood pressure (DBP) of the study popula- Tripura district of Tripura. Cluster sampling method was fol- tion were calculated. Systolic blood pressure and Diastolic blood lowed for selecting 458 apparently healthy rural Tripuri tribal pressure were found to be progressively accelerating with ad- boys. Age of each subject was verified from school records. After vancement of age (Fig.1). Prehypertension in children is defined obtaining informed consent from the parents, all childrens ware as a systolic or diastolic pressure equal to or greater than the measured on schools. Those on anti-hypertensive medication 90th percentile but less than the 95th percentile. and known to have chronic heart, renal or hepatic disease were excluded. Information on age, sex and family history of hyper- Table 1: Descriptive statistics of rural Tripuri tribal boys (6 14 IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Research Paper Volume : 4 | Issue : 1 | January 2015 • ISSN No 2277 - 8179 to 18 years of age). DISCUSSION It is important to determine the prevalence of hypertension and prehypertension in children, not only because it varies from one Waist circumference (cm) BMI (kg/m2) community to the other (Jafar et al., 2005), but also because it Age (yrs.) n is essential to identify the population at risk. Early identifica- Mean SD Mean SD tion translates into early interventions and possibly prevention of later morbidity and mortality (NIH et al., 2005). In the stud- 6 30 48.47 1.86 13.67 0.79 ied school children 9.39% had prehypertension and an addi- tional 2.62% had hypertension. This reflects an alarming situa- 7 30 50.29 2.82 14.18 1.14 tion, where these children need some intervention as guided by the Fourth Task Force recommendations (NIH et al., 2005). The 8 37 53.73 4.63 14.54 1.09 rates of high blood pressure in our study are marginally lower than those reported by an Indian study (Sharma et al., 2010). 9 31 54.79 5.67 15.33 1.89 Within India, regional differences in blood pressure among chil- dren were found (Krishna et al., 2007). The association between 10 47 54.46 2.46 14.79 0.89 elevated blood pressure and high BMI observed by us has been noted by various workers including few from India (Peixoto et 11 33 54.09 3.61 15.01 0.69 al., 2006; Anand and Tandon, 1996; He et al., 2006). 12 35 60.92 3.99 16.91 1.60 Table 2: Prevalence of hypertension among rural Tripuri tribal boys of Tripura. 13 36 61.44 4.13 16.81 1.20 BP percentile BP percentile ≥ th th th th BP percentile ≥ 95 14 41 63.14 4.79 17.71 1.84 Age < 90 90 – <95 (years) (Normal) (Prehypertensive) (Hypertensive) 15 32 62.71 3.00 17.97 1.67 6 27 (90)* 3 (10) 0 16 36 66.08 2.57 19.83 1.18 7 30 (100) 0 0 17 44 68.10 4.91 20.29 1.97 8 37 (100) 0 0 18 28 69.00 3.50 21.11 1.32 9 31 (100) 0 0 10 40 (85.11) 5 (10.64) 2 (4.26) 11 29 (85.29) 3 (8.82) 1 (2.94) 12 35 (100) 0 0 13 28 (77.78) 7 (19.44) 1 (2.78) 14 41 (100) 0 0 15 32 (100) 0 0 16 21 (58.33) 12 (30.77) 3 (7.69) 17 33 (75) 8 (18.18) 3 (6.82) 18 19 (73.08) 5 (19.23) 2 (7.69) Total 403 (87.99) 43 (9.39) 12 (2.62) * Figures mentioned in parentheses are percentage. Figure 1: Blood pressure pattern with age in rural Tripuri For the determination of relationship between blood pressure tribal boys. and obesity we uses BMI and waist circumference as component of adiposity (Peixoto et al., 2006; Soudarssanane et al., 2008). The Hypertension in the young is defined as systolic or diastolic interrelationship between blood pressure and various anthro- blood pressure that is repeatedly above the 95th percentile for pometric indices reveals that the correlation between Systolic age and sex (NIH, 2005).