Indian Journal of Community Medicine Vol. 31, No.

3, July - September, 2006

164
High Blood Pressure/ Hypertension in Adolescents
Key Predictors of High Blood Pressure and Hypertension among Adolescents:
A Simple Prescription for Prevention
M.B. Soudarssanane, M. Karthigeyan, S. Stephen, A. Sahai
Abstract
Research Question: What is the distribution of blood pressure and prevalence of hypertension among adolescents? What are
the risk factors involved? Objectives: To assess the blood pressure levels and prevalence of hypertension among adolescents
(15-19 years) and identify the risk factors associated with high blood pressure and hypertension. Design: Cross-sectional
study and confrmatory community-based case control study. Setting: Jawaharlal Institute Urban Health Center service
area at Kuruchikuppam, Pondicherry, India. Participants: 673 adolescents (males 351, females 322) in the 15-19 years age
group. Statistical Analysis: Nomogram; Univariate analysis followed by Logistic Regression; Odds Ratio. Results: Mean
SBP and mean DBP were 113.6 and 74.3 mm Hg respectively (114.1 & 74.6 in males, 113.1 and 74.1 in females). Mean
blood pressure (MBP) showed signifcant correlation with age. MBP and prevalence of hypertension increased with social
class, salt intake, parental history of hypertension, weight, height and BMI. Of these, BMI and higher salt intake emerged as
independent predictors by multivariate analysis. Findings were confrmed by the case control study. Conclusion: The major
risk factors for hypertension among adolescents are BMI and higher salt intake.
Keywords: Blood Pressure, Prevalence, Hypertension, Adolescents, BMI, Cross Sectional Study, Nested
Community-Based Case Control Study.
Deptt. of Preventive and Social Medicine,
JIPMER, Pondicherry.
E-mail: kgy@sify.com & drmybase@sify.com
Received 11.10.2004
Introduction
Cardiovascular diseases, particularly hypertension, account
for high mortality in the form of coronary heart disease (CHD)
in western countries and stroke in countries like India, Taiwan
and Japan
1
. Hypertension also contributes to cardiac or
renal failure. The higher the blood pressure the greater is
the risk and lower the expectancy of life. Many of the risk
factors associated with development of hypertension are
preventable. Several community-based studies are available
in India regarding prevalence of hypertension
2-5
.
In Pondicherry, the Department of Preventive and Social
Medicine (PSM) in the Urban Field Practice area of
Jawaharlal Institute of Post graduate Medical Education
and Research (JIPMER) over the last decade have done
the following studies on Blood Pressure Distribution and
Prevalence of Hypertension so far, among adults. Srinivas
6
in
1991 reported mean SBP of 117 mmHg and mean DBP of 74
mmHg among 1025 adults with prevalence of hypertension
of 5.5%. Muralidharan
7
followed the same cohort in 1996
and recorded mean blood pressure of 121/82 mmHg and
prevalence and incidence of 7.1 % and 1.4% respectively.
Since data from adolescents of the same population would
enable a complete understanding of the dynamics of blood
pressure and hypertension, this study was undertaken
with the following objectives: To describe the distribution
of blood pressure among adolescents aged 15-19 years in
an urban slum community and to assess the relationship
of blood pressure and hypertension in the study population
with factors like age, sex, religion, education, occupation,
income, body mass index, physical exercise, stress, salt
intake, type of food intake, smoking, alcohol consumption,
parental history of diabetes mellitus/ hypertension and use
of oral contraceptives (OCP) (as relevant).
Materials & Methods
Ethical clearance for this study was accorded by JIPMER
ethical committee in May, 2002. The study was carried at the
Jawaharlal Institute Urban Health Center (JIUHC), which is
the urban feld practice area of Department of PSM, JIPMER,
Pondicherry, between March & December 2002 (feldwork -
May to July 2002). The reference population for the study was
all adolescents in age group 15-19 yrs. The JIUHC serves a
population of approximately 8600 in 1760 families. The center
maintains a well-established medical records system, with
family folders for every family and separate case sheets for
every individual in the family. The population in 15-19 years
was only 850 as per records. Hence the whole population
was included as the study population.
Data collection was done, after obtaining informed consent,
by house-to-house visit using pretested questionnaire. In
addition to data on identifcation and socioeconomic status,
the following information were collected: Physical exercise
(Very good-Physical exercise like manual work per se or
sports activity (or) Physical work for more than three hours
a day, Moderate- 1 to 3 hours a day, Mild- less than 1 hour
a day); Stress- Subjective, based on selected negative life
events (Loss of mother/ father/sibling/close relatives/friends,
unemployment/ loss of job, low performance in studies,
unpleasant relationship in the family, love failure); Per capita
salt intake (Total amount used by the family per day in grams
/ No. of persons in the family); Type of food (vegetarian or
non-vegetarian); Parental history of Hypertension/ Diabetes
mellitus; OCP use (only for married females); Smoking habits
(Light- upto 5 cigarettes/day, Moderate- 6 to10/day, Heavy

Indian Journal of Community Medicine Vol. 31, No. 3, July - September, 2006
165
High Blood Pressure/ Hypertension in Adolescents
- more than 10/day); Alcohol consumption (Occasional- once
or twice a month, Frequent- once or twice a week, Always-
more than twice a week); Anthropometrical measurements:
Height was recorded to the nearest centimeter and weight to
the nearest half kilogram. The Quetlets index was calculated
according to the formula: Quetlets index = Weight in Kgs.*
100 / (Height in metres)
2
. (<5
th
percentile- Underweight, >5
th

percentile to <85
th
percentile- Normal, _>85
th
percentile-
Risk of overweight, _>95
th
percentile-Overweight)
8
. The
WHO criteria
9
was followed in recording blood pressure and
average of two readings recorded 3 minutes apart was taken
as BP. A nomogram for distribution of BP for the individual age
and sex in 15-19 yrs age group was constructed; values at
95
th
percentile and above were taken as hypertension
10,11
.
For an inbuilt cross verifcation of results, a nested community
based case control study was done with the identified
hypertensives as cases and controls (matched for age,
sex and social class) chosen from within (-)1 SD of blood
pressure distribution for each age level, in 1:1 ratio.
Analysis was done using SPSS 7.5 package, Pearsons
correlation coefficient, one-way ANOVA, Independent
Samples `t test and multivariate analysis using Logistic
regression. Case control study was analyzed using EPI
INFO 2000.
Results
Out of the 850 study population, 673 (79.2%) were contacted
(351 males and 322 females). Thirty-four people had shifted
residences, four did not give consent, and the remaining were
untraceable even after four visits.
A nomogram was constructed for the study population (15-19
years). At least 50 males and females were present in each
age group. The 5
th
and 95
th
percentiles for Systolic Blood
Pressure (SBP) for 15 years of age were 91.6 mm Hg and
127 mm Hg respectively, and for Diastolic Blood Pressure
(DBP) were 58.3 and 88.7 respectively. At 19 years of age,
the 5
th
and 95
th
percentiles for SBP were 100.0 and 131.0 and
the corresponding values for DBP were 60.0 and 89.0 mm
Hg. The details of the nomogram of blood pressure for both
genders in all the ages studied are shown in Table I.
Overall, the mean SBP and mean DBP were 113.6 mm Hg
(range 81 to 169) and 74.3 mm Hg (46 to 101) respectively.
Mean SBP among the male participants was 114.1 (81 to
169) and the mean DBP was 74.6 (46 to 101). Females had
mean SBP and mean DBP of 113.1 (93 to 138) and 74.1 (49
to100) respectively. The difference of mean blood pressure
among the genders was not signifcant.
Out of 673, 57 had hypertension (prevalence of 8.5%).
Among 351 males, 33 were hypertensive (9.4%) and
among 322 females, 24 were hypertensive (7.5%). Of the
57 hypertensives, 21.0% (12) had both systolic and diastolic
hypertension, 38.6% (22) had Isolated Systolic hypertension
(ISH) and the other 40.4% (23) Isolated Diastolic hypertension
(IDH). Among males, 39.4% (13) were Systolic hypertensives
and 45.5% (15) were Diastolic hypertensives. Among females
these were 37.5% (9) and 33.3%(8).
Table I: Blood Pressure Percentiles Among The Study Population
Percentiles
Age
(Yrs) 5 10 25 50 75 90 95
15 90.1 93.2 103 111 119 124 130.8
SBP 16 96.5 98.8 100.7 103 111 120 12S.2
mm 17 98.9 100.7 108 114 119.8 124 128.2
Hg 18 97 103.6 109 115 122 133.2 138.2
19 100 103.1 110 117 124 130 133.9
Males 15 55.3 60 67 73 80 84 88.9
n=351 DBP 16 59.5 60.8 68 73 80 86 87.4
mm 17 SS.6 60 67.3 73.5 79.8 84.9 87.8
Hg 18 60 63.4 69 76 82 88 92.5
19 60 61 72 78 81 88 89
15 99.3 100 105.3 113.5 117.8 123 124
SBP 16 98 100 106 113 117.5 123 128
mm 17 103 107.7 111 115.5 120 122.3 127.8
Hg 18 99 101 106 113 118 125.6 129
19 99 103 107 113 117 123.1 127.9
Females 15 59.3 60.5 68.3 75 79 85 88.8
n=322 DBP 16 58 61 69 75 80 85 88.5
mm 17 56.3 63 69.5 77 75 74.5 77
Hg 18 57.8 60 69 75 78 82.6 87.8
19 59.2 61.9 69 74.5 79 81.7 85.9
15 91.6 99 104 113 118 123 127
SBP 16 98 99 104.8 113 119 123.3 128
mm 17 99.7 103.9 110 114.5 120 123 127.4
Hg 18 98.5 101 108 114 120 129 135.1
19 100 103 108.8 115 120 128.7 131
Overall 15 58,3 60 68 74 79.5 84 88.7
n=673 DBP 16 59.4 61 68.8 74 80 86 87.7
mm 17 56.7 60 69 75.5 80 84 87
Hg 18 59 61 69 75 80 85.7 89
19 60 61 70 77 80 85.7 89
Table II: Age Wise Distribution of Blood Pressure And Hypertension
Males Females Overall
Mean Mean HT
C
Mean Mean HT Mean Mean HT
Age No. SBP
a
DBP
b
No. No. SBP DBP No. No. SBP DBP No.
(yrs) (SD) (SD) (%) (SD) (SD) (%) (SD) (SD) (%)
15 81 110.8 72.9 5 64 112.6 74.2 3 111.6 73.5 8
(12.4) (9.5) (6.2) (7.8) (8.b) (4.7) 145 (10.6 (9.1) (5.5)
16 57 111.8 73.4 4 69 112.2 74.2 4 126 112 73.8 8
(10.1) (8.6) (7.0) (8.6) (9.3) (5.8) (9.3) (8.9) (6.3)
17 56 114 73.3 4 53 115.3 75.1 4 112 114.7 74.2 8
(8.6) (9.6) (7.1) (6.9) (8.4) (7.1) (7.8) (9.0) (7.1)
18 77 116.5 76.1 5 71 113.2 73.4 3 148 114.9 74.8 8
(12.3) (9.6) (6.5) (8.9) (8.6) (4.2) (10.9) (9.2) (5.4)
19 80 116.9 76.5 6 62 112.6 73.8 4 142 115 75.3 10
(9.9) (8.5) (7.5) (7.7) (7.7) (6.5) (9.3) (8.2) (7.0)
Total 351 114.1 74.6 33 322 113.1 74.1 24 673 113.6 74.3 57
(11.2) (9.3) (9.4) (8.1) (8.5) (7.5) (9.8) (8.9) (8.5)
Pearsons correlation coeffcient : r (overall) = 0.14*(sbp) & 0.78*(dbp)
r (males) = 0.22*(sbp) & 0.16*(dbp)
r (females) = 0.02 (sbp) & -0.03 (dbp)
*signifcant at 0.05 level

a
Systolic blood pressure

b
Diastolic blood pressure

c
Hypertension

Indian Journal of Community Medicine Vol. 31, No. 3, July - September, 2006
166
High Blood Pressure/ Hypertension in Adolescents
Even within this short span of fve years in the study group of
15 - 19 years the mean blood pressure increased signifcantly
with age (r = 0.14 for SBP and 0.78 for DBP) (Table II).
Although this rising trend was observed in both genders, it
was signifcant only among males (r = 0.22 and 0.16).
Analysis of social class was based on Kuppuswamys
scale
12
adjusted for Wholesale Price Index
13
. Only the overall
difference of SBP among the social classes was signifcant.
Of the total 673, none were eligible to be included in the upper
social class. The overall mean SBP among upper middle
(UM) class was 116.5 mm Hg, lower middle (LM) class was
117.1, upper lower (UL) class was 113.3 and lower class (L)
was 112.1 mm Hg. The respective DBP were 76.7, 75.0, 74.2
and 76.6 mm Hg. The overall prevalence of hypertension in
UM was 10%, LM 9.8%, UL 8.2% and L class 12.5%. Among
males, the prevalence of hypertension was 18.2%, 13.2%,
8.6% and 0% respectively and among females it was 0%,
0%, 7.9% and 12.5%.
Unlike the fndings reported in adults, there was no effect
of physical exercise, stress, type of food intake, smoking
and alcohol consumption on blood pressure among
adolescents.
As regards salt intake, the response rate was 93.2% (627),
the remaining unable to quantify the salt used. Overall only
mean DBP was signifcantly associated with the amount
of salt intake which is also true for both genders. The
overall mean SBP was signifcant at 0.046 level and was
not refected in the genders. The overall prevalence of
hypertension was found to increase with increased amount
of salt intake (Table III).
Parental history of hypertension and diabetes mellitus was
obtained using the Tamil equivalents ratha kodhipu and
sakkarai vyadhi or thithipu neer respectively. Persons with
positive history of parental hypertension showed signifcant
elevation in both mean SBP (115.9 mmHg) and mean DBP
(76.1) compared to those who gave no history of parental
hypertension. Among the genders only the rise in mean
SBP among males was signifcant (Table IV). The overall
prevalence of hypertension in persons with positive history
of parental hypertension was 11.6% compared to 8% in the
other group (males 12.1 & 8.9, females 10.8 & 7).
On further analysis based on history of paternal and
maternal hypertension, the mean SBP and mean DBP in
individuals with history of paternal hypertension were 115.4
mm Hg and 74.8 mm Hg. The values for those with history
of maternal hypertension were 114.8 mm Hg and 76.5 mm
Hg respectively. It was observed that subjects with both
paternal and maternal hypertension had signifcantly higher
mean SBP (124.9 mm Hg) and mean DBP (79.9 mm Hg)
than those with either paternal or maternal hypertension. This
was true for both genders. The prevalence of hypertension
in subjects with both paternal and maternal hypertension
was 37.5%, which was higher than that observed in subjects
with only paternal (4.9%) of maternal hypertension (13%).
The prevalence was 8% in individuals who gave no parental
history of hypertension.
Overall, subjects whose parents were diabetic had higher
SBP and DBP than those with no parental history of diabetes
mellitus. A similar rising tendency of blood pressure was found
in both genders but no statistical signifcance emerged.
Only 0.9% of the female participants gave history of OCP
use. Though no signifcant difference in blood pressure was
found between OCP users and non-users, the variation in
DBP (difference of 7.5 mm Hg) was much greater than that in
SBP (1.8 mm Hg) between the two groups. The prevalence
of hypertension among non-users of OCP was 7.5% and
0% among users.
The overall mean SBP and mean DBP increased signifcantly
with increasing weight (r = 0.44 for SBP and 0.27 for DBP)
and height (r=0.21 for SBP and 0.10 for DBP). Observation
showed a clear-cut rise in the prevalence of hypertension
only with increasing weight (chi sq = 64.84, p<0.05).
Table III: Distribution of Blood Pressure And Hypertension According
to Salt Intake
Males Females Overall
Mean Mean HT
C
Mean Mean HT Mean Mean HT
Age No. SBP
a
DBP
b
No. No. SBP DBP No. No. SBP DBP No.
(yrs) (SD) (SD) (%) (SD) (SD) (%) (SD) (SD) (%)
<15 238 113.2 73.5 15 238 113.2 74.5 21 476 113.2 74 36
(10.6) (9.1) (6,3) (8.1) (8.4) (8.8) (9.5) (8.8) (7.6)
-20 51 114.9 77.0 10 55 112.6 73.8 2 106 113.6 75.4 12
(12.1) (8.5) (19.6) (7.9) (8.6) (3.6) (10.1) (8.7) (11.3)
-25 22 119.5 76 3 16 114.8 71.9 1 38 117.5 74.2 4
(14.9) (9.8) (13.6) (10.0) (8.1) (6.3) (13.1) (9.2) (10.5)
-30 2 117.5 83.0 0 4 115.8 62 0 6 116.3 69.0 0
(6.4) (2.8) (0.0) (3.8) (11.4) (0.0) (4.2) (14.1) (0.0)
>30 1 129 99 1 0 0 0 0 1 129 99 1
(0.0) (0.0) (100) (0.0) (0.0) (0.0) (0.0) (0.0) (100)
Total 314 113.9 74.4 29 313 113.2 74.1 24 627
b
113.6 74.2 53
(11.3) (9.2) (9.2) (8.1) (8.6) (7.7) (9.8) (8.9) (8.5)
a
P <0.05
b
n =627 (For the remaining, reliable information regarding salt intake was not available)
Table IV: Distribution of Blood Pressure And Hypertension According
to Parental History of Hypertension
Pare- Males Females Overall
ntal No. Mean Mean HT
C
Mean Mean HT Mean Mean HT
H/O SBP
a
DBP
b
No. No. SBP DBP No. No. SBP DBP No.
Hyper- (SD) (SD) (%) (SD) (SD) (%) (SD) (SD) (%)
tension
Yes 58 116.9 75.9 7 37 114.2 76.4 4 95 115.9 76.1 11
(I2.0) (9.2) (12.1) (9.5) (8.3) (10.8) (11.1) (8.8) (11.6)
No 293 113.6 74.3 26 285 113.0 73.8 20 578 113.3 74.1 46
(10.9) (9.3) (8.9) (7.9) (8.5) (7) (9.5) (8.9) (8.0)
114.1 74.6 33 322 113.1 74.1 24 673 113.6 74.3 57
Total 351 (11.2) (9.3) (9.4) (8.1) (8.5) (7.5) (9.8) (8.9) (8.5)s
a
P < 0.05

Indian Journal of Community Medicine Vol. 31, No. 3, July - September, 2006
167
High Blood Pressure/ Hypertension in Adolescents
A signifcant positive correlation was found between blood
pressure and BMI (r = 0.36 for SBP and 0.24 for DBP). The
mean SBP among subjects with underweight was 105.9 mm
Hg. Those within the normal range of BMI showed mean SBP
of 112.3 mm Hg. Individuals at risk of overweight and those
with overweight had mean SBP of 119.3 and 123.9 mm Hg.
The respective mean DBP were 72.8, 73.4, 77.8 and 81.1
mm Hg. The signifcance observed between the groups was
true for individual ages and genders.
Variables found to be signifcant on univariate analysis (age,
social class, salt intake, parental history of hypertension and
BMI) were subjected to logistic regression analysis and Body
Mass Index in both genders and salt intake among males
turned out to be signifcant risk factors (Table V).
These fndings were confrmed by the nested community-
based case control study (n = 54+54). Controls were not
available for three cases. However, in addition to BMI and salt
intake among males, the case control study also identifed
parental history of hypertension as a signifcant risk factor
(Table VI).
Discussion
In the present study among adolescents aged 15-19 years
in urban slum of Pondicherry, both mean SBP and mean
DBP were higher among males than females. Elsewhere,
studies on population of 13-18 years
14
, 15-24 years
15
and
15-25 years
16
observed higher mean SBP among males and
higher mean DBP among females.
The defnition of hypertension among adolescents is 95
th

percentile of blood pressure and above
10,11
. This defnition
was used in our study. However, since comparative height
adjusted values of blood pressure were not available for
Indian population, we have used the non-height adjusted
values. This is a limitation in the study.
Since the defnition of hypertension is 95
th
percentile and
above, the prevalence measured is expected to be between
5% and 10%, allowing for a theoretical probability of 5%
ISH and 5% IDH. Hence comparison with other studies is
not attempted in this discussion. In our study, 38.6% of the
hypertensives were due to isolated rise in systolic blood
pressure. This Isolated Systolic Hypertension deserves
attention as it is an important risk factor of coronary heart
disease and stroke independent of diastolic status of the
individual
17-21
.
The tendency of blood pressure to rise with age is supported
by findings from Turkish study among 13-18 years
22
,
Zambian school children (7-16 years)
23
and German study
(4-18 years)
24
. In the Jamaican study (6-16 years)
25
, blood
pressure increased with age in both boys and girls, although
the increase was greater for SBP than for DBP; however,
the increase of SBP among boys continued after the age of
l1 years but that for girls leveled off. In the present study,
both SBP and DBP rose with age only among males. The
UK study
14
found age related rise only in SBP and only in
males.
The SBP was signifcantly related to the socio-economic
status of the adolescents as also reported by Gilberts et
at
2
. Life style modifcation between the upper and lower
socioeconomic classes could have had an indirect bearing
on the blood pressure levels.
Physical activity influencing the blood pressure is well
documented in many studies among adults; however no
signifcant association was found between the two in these
urban adolescents. Probably exercise alters blood-pressure
levels only in its long-term practice and the follow up study of
Table VI: Results of Nested Case Control Study As A Confrmation of
Findings of Cross Sectional Study
Risk factor Risk Factor present Exact 95%
CI for p value
Cases
a
Controls
a
OR OR
Salt intake
b
13 8 1.86 0.62-5.82 0.2157
(10)
c
(3) (5.00) (1.41-32.20) (0.0230)
Exercise 21 17 1.39 0.58-3.31 0.4202
Stress 4 11 0.31 0.07-1.17 0:0515
Diet 54 54 .... .... ...
Family h/o 9 2 5.20 0.99-51.22 0.0259
hypertension
Family h/o 6 8 0.72 0.19-2.58 0.5667
Diabetes
mellitus
Smoking /
d
6 5 1.25 0.28-5.90 0.7386
Alcohol-
ism
Body mass index 23 2 19.29 4.18-175.48 < 0.0001
a
n = 54 as controls were not available for 3 cases.
b
n = 47 as data was not available for 4 cases and 3 controls.
c
Males (n=24)
d
Applicable only for males
Table V: Logistic Regression Analysis of Hypertension for Risk Factors Identifed By Univariate Analysis
Variables Males Females Both
B Sig R Exp.B B Sig R Exp.B B Sig R Exp.B
Age -0.4912 0.2627 <0.000^ 0.6119 0.1106 0.8035 <0.000^ 1.1170 -0.2071 0.4882 0.0004 0.8130
Social class -0.1553 0.7979 0.0004 0.8562 -7.1669 0.7250 <0.0004 0.0008 -0.4172 0.4002 0.0000 0.6589
Salt Intake 1.2458 0.0047 0.1762 3.4757 -0.7257 0.2623 Z,0.000 0.4840 0.5290 0.1062 0.0410 1.6993
Family h/o -0.2233 0.6809 <0:0004 1.2502 0.1839 0.7659 L0.0001 1.2020 0.2021 0.6099 0.0000 1.2239
hyperten-
sion
Body mass 1.9959 <,0.0004 0.2898 7.3590 1.6304 0.0003 0.2581 5.1059 1.6876 1 0.0004 0.2766 5.48627
Index

Indian Journal of Community Medicine Vol. 31, No. 3, July - September, 2006
168
High Blood Pressure/ Hypertension in Adolescents
the cohort may yield different results. However, even among
adolescents, inverse relationship between DBP and exercise
has been demonstrated
14
.
It is generally agreed that stress aggravates blood pressure
and predisposes the individual to develop hypertension
but the present study showed even lower blood pressure
(though not signifcant) in subjects with stress. It is possible.
that the subjective method adopted to quantify stress in this
study being subjective could have had an impact on the
outcome.
Even at this young age, dietary salt signifcantly affects mean
DBP but not mean SBP.
In the present study, subjects in whom positive family history
of hypertension was elicited had higher blood pressure. The
prevalence of hypertension was also higher in them. This
suggests, there is a genetic role to play in the development
of hypertension. Familial tendency for developing high blood
pressure is well known. A positive parental history of high
blood pressure was associated with higher SBP and DBP.14
Individuals for whom both the parents were hypertensive
showed signifcantly higher blood pressure than those with
either paternal or maternal hypertension. The prevalence
of 37.5% in the former which is defnitely higher than the
latter [4.9% in paternal hypertension and 13% in maternal
hypertension] provides clue to target population for blood
pressure screening. Though blood pressure rose with positive
parental history of diabetes mellitus, it was not signifcant.
That the parental hypertension / diabetes elicited only by way
of history, has a low sensitivity, is a limitation of the study.
Although many studies carried out in adults had put forth
strong evidence of association between smoking/alcoholism
and hypertension, the present one did not fnd any signifcant
difference in blood pressure between smokers and non-
smokers in adolescents. The possible explanation is that the
amount and duration of exposure to smoking and drinking
habits may not be suffcient enough to bring out a real change
in blood pressure levels in young age. A follow up study of
the cohort could bring out the possible relationship between
the two. However, a J shaped association of alcohol intake
with blood pressure was shown in young adults aged 18
- 26 years
26
.
The present study found signifcant rise in both SBP and DBP
with increasing weight in both genders. This compares with
the fndings from adolescents aged 17 years in Jerusalem
27

whereas another study 14 reported weight dependent rise
in blood pressure only among males with respect to SBP
alone. Studies on population of 4-18 years
24
and 7-16 years
23

also identifed weight to be a major determinant of blood
pressure which is important as the childhood weight gain
was positively associated with adult blood pressure
28
. With
reference to height, association of blood pressure reported
in the present study agrees well with other study
14
. Some
studies have reported the association of blood pressure with
both weight and height
22252930
.
It is evident from this community based epidemiological
survey that increase in BMI predisposes the adolescent
individual to higher blood pressure and subsequently
hypertension. A similar fnding was also reported elsewhere
in India
31
Hungary
32
and France
33
. Such association in early
childhood with SBP alone was reported by Sinaiko et al
34
and
Hardy et al
35
. Trevor. J.orchard
14
reported similar association
only in SBP among males. Present study results, obtained
after multivariate analysis strengthens the independent
association of BMI with blood pressure.
Finally, it can be concluded from both the multivariate analysis
and the case control study that even in the adolescent
population, pathogenesis of higher blood pressure is a
process infuenced by life style factors like higher BMI and
higher salt intake. The case control study however identifes
parental history of hypertension also as a risk factor.
Acknowledgements
We gratefully acknowledge Indian Council of Medical
Research (ICMR) New Delhi, for sponsoring this study.
We thank Mohan Kumar for his assistance in analysis, the
staff of JIUHC for their cooperation in the feldwork and the
adolescent participants of this study.
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