RISK FACTORS IN DETERMINING PREHYPERTENSION

AMONG UNIVERSITY STUDENTS IN DAVAO CITY

Erika Jeanne Alcera

Jessaree Acebes
Jana Ariquez
Jeune Marielle Gabutero
Clarice Joy Mamingao

NMD 1C
INTRODUCTION

BACKGROUND OF THE STUDY

Nearly one billion people have hypertension globally and 1.56 billion adults are estimated
to acquire it by the year 2025. Among the 8 million people who die every year due to hypertension
globally, 1.5 million are from Southeast Asia (WHO, 2011). In the Philippines, roughly 50% of 84
million Filipinos had hypertension in 2003 (Plaza, St, & Complex, 2012). Over 12 million Filipinos
are suffering from hypertension making it one of the primary contributors to premature deaths in
the Philippines. It was tagged as a “silent killer” because more than half of people with
hypertension are unaware of their condit (Department of Health, 2019). A study in 1996 shows
that diseases of the circulatory system accounted for 30% of all deaths across the country. A
more recent national nutrition survey also revealed that 21% and 44.3% of adults below and above
the age of 60, respectively were hypertensive (Adair, 2004) . Most of the disease burden caused
by high blood pressure is borne by low-income and middle-income countries, by middle-aged
people, and by people with prehypertension (Lawes et. al., 2001).

The Seventh Report of the Joint National Commission or JNC 7 on High Blood Pressure
established prehypertension as a new risk category (Liszkaet, al., 2005). Prehypertension is
considered when an individual’s blood pressure is higher than normal but not high enough to be
considered as high blood pressure. Usually a higher than normal blood pressure is asymptomatic,
thus blood pressure cuffs are used to monitor if a person’s blood pressure is within the normal
range (Gregory Thomspon and Kloner, 2011). The concept of prehypertension is important as it
defines a detailed study of the risks of elevated blood pressure (Hu et al., 2017)

Prehypertension can be associated with increased risk of major cardiovascular events

independent of other cardiovascular risk factors. These findings, along with the presence of
cardiovascular risk factors in the majority of participant sample with prehypertension, support
recommendations for physicians to actively target lifestyle modifications and multiple risk
reduction in their prehypertensive patients (Lizska et. al., 2005).

People with blood pressure levels between 120/80 and 140/90 have twice the risk of
developing serious cardiovascular risks. Those with blood pressure levels above 140/90, which
is considered as hypertension, have four times the risk (Shaw, 2019). Approximately 23% of the
population are prehypertensive where 25% of which is likely to develop full-blown hypertension.

As hypertension remains one of the leading cause of death worldwide, several programs
and policies have been established to address the growing concern. In 2016, the World Health
Organization and the United States Centers for Disease Control and Prevention established the
Global Hearts Initiative. It has 5 technical packages: (1) HEARTS - a guideline on detection and
treatment of hypertension, (2) MPOWER - to control tobacco, (3) Active - to increase physical
activity, (4) SHAKE - to reduce salt consumption, and (5) REPLACE - to eliminate trans-fat. A
World Hypertension Day has also been created and is celebrated every 17th of May (WHO, 2019).

In the Philippines, the former president Gloria Macapagal-Arroyo signed Proclamation no.
1761 on May 1, 2009 declaring the month of May as “Hypertension Awareness Month”. This
encourages all government and non-governmental agencies, such as the Department of Health
and the Department of Social Welfare and Development and Philippine Society of Hypertension
to work together in preventing and controlling hypertension in the country (Official Gazette, 2009).
The Department of Health also implemented several policies and laws such as AO No. 2011-
0003 or The national policy on Strengthening the Prevention and Control of Chronic Lifestyle
Related Non-Communicable Diseases, Administrative Order No. 2012-0029 or The Implementing
Guidelines on the Institutionalization of Philippine Package of Essential NCD Interventions
(PhilPEN) on the Integrated Management of Hypertension and Diabetes for Primary Health Care
Facilities, AO No. 2013 – 0005 or The National Policy on the Unified Registry Systems of the
Department of Health (Chronic Non-Communicable Diseases, Injury Related Cases, Persons with
Disabilities, and Violence Against Women and Children Registry Systems) and AO 2016 – 0014
- Implementing Guidelines on the Organization of Health Clubs for Patients with Hypertension
and Diabetes in Health Facilities. The Philippine Heart Month on February and World Tobacco
Day on May is also celebrated annually (DOH, 2018). For this year’s hypertension awareness
month, the theme is #KnowyourNumbers which aims to encourage everyone to have their blood
pressure measured and monitored (Philippine Council for Health Research and Development,
2018).

Aside from the different programs that highlight on raising consciousness about
hypertension among Filipinos, the Philippine Council for Health Research and Development
(PCHRD) supports researches on hypertension under the National Unified Research Agenda
(NUHRA). Also, PCHRD’s Tuklas Lunas Program focuses on discovering and developing drugs
out of the natural resources of the country (Philippine Council for Health Research and
Development, 2018).

Despite such efforts, hypertension remains as the leading single risk factor for deaths
worldwide. There are still about 21% Filipino adults with hypertension and an increasing
prevalence of hypertension in the country where 16% Filipino adults 20 years and above are
hypertensive (Philippine Council for Health Research and Development, 2012).

The presence of hypertension among children and young adults are now prevalent all over
the world. This situation is largely due to the current lifestyle every adolescent is having (Redwine
& Daniels, 2012). Former Health Secretary Enrique Ona stated that hypertension is a public
hazard that can afflict elementary students. Moreover, Dr. Susan Pineda-Mercado, the acting
WHO representative of the Philippines, identified hypertension not an illness only of old people
as there are already young people below 30 years old who are hypertensive (Jaymalin, 2013).
This raises a concern on the health status of young individuals. With this, this study aims to
determine the prevalence of prehypertension among college students in Davao City.
REVIEW OF RELATED LITERATURE

Blood Pressure

Blood pressure is the measure of the force of blood against blood vessel walls. High blood
pressure, also called hypertension, is dangerous as it compels the heart work harder by pumping
blood out of the body (WHO, 2011). Hypertension with blood pressure values of 120–139/80–89
mm Hg is not only a well-known risk factor for cardiovascular disease, but is also considered as
a public health challenge worldwide. (Lihua et al., 2017).

High blood pressure can rupture or block arteries that supply blood and oxygen to the
brain, causing a stroke. In the kidneys, adults with diabetes, high blood pressure, or both have a
higher risk of developing chronic kidney disease than those without such conditions. Lastly, high
blood pressure can harden your arteries, which decreases the flow of blood and oxygen to your
heart which leads to heart disease. (CDC, 2014).

According to the Centers for Disease Control and Prevention (2019a), blood pressure
levels can be categorized as normal, prehypertensive, or high, depending on its systolic and
diastolic rate. As shown in Table 1, in normal blood pressure levels, systolic rate is less than 120
mmHg and diastolic rate is less than 80 mmHg. It is classified as prehypertension if the systolic
rate is 120-139 mmHg with a diastolic rate of 80-89 mmHg, while hypertension is considered
when a patient has 140 mmHg or higher and 90 mmHg or higher respectively.

Table 1. Classification of Blood Pressure Levels (CDC, 2019a)

BLOOD PRESSURE LEVELS

Systolic: Less than 120 mmHg
Normal
Diastolic: Less than 80 mmHg
Systolic: 120 – 139 mmHg
At risk (Prehypertension)
Diastolic: 80 – 89 mmHg
Systolic: 140 mmHg or higher
High
Diastolic: 90 mmHg or higher

A report of the American College of Cardiology/ American Heart Association Task Force
on Clinical Practice Guidelines, on the other hand, presented a different classification which they
published in GUIDELINES MADE SIMPLE: 2017 Guideline for the Prevention, Detection,
Evaluation, and Management of High Blood Pressure in Adults. The said classification is
summarized in Table 2.
 Table 2. Classification of hypertension from 2017 Guideline (American College of Cardiology,
2017)

In the Philippine context, the guideline presented by the Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
in 2003 is being followed (Elliot & Black, 2007).
Table 3. Comparison of BP Target Recommendations

The 2017 guideline was conducted with a bulk population of 98% Caucasian Americans
and only 2% which belongs in the Asian ethnicity. (Philippine Heart Association [PHA], 2018).
With this, the 2003 guideline will be used for the entirety of this study.

Hypertension

Hypertension is considered as one of the major risk factors for cardiovascular disease and
is classified as a blood pressure of ≥140/90. Hypertension is famously referred as the “silent killer”
since majority of the people who develop this do not show any symptoms (World Health
Organization, 2011). 26% of people, approximately 972 million, worldwide are hypertensive and
this prevalence will increase continuously to 29-30% by 2025. High blood pressure is a major
contributor for stroke and heart disease, both are leading causes of death in the world (Alexander,
2019).

In the Philippines, 21% of Filipinos are hypertensive and almost half of them are unaware of it.
Hypertension among Filipino adults (20 years old and above) had a significant increase in
prevalence from 22.3% to 23.9% in 2014 to 2015 (Agron, 2019). It is the third leading cause of
morbidity in the country following acute respiratory infection, and ALTRI and pneumonia .

Table 4. Leading Causes of Morbidity in the Philippines 2018

According to CDC (2014), the main risk factors involved in developing high blood pressure
are health conditions, lifestyle, and family history. Other risk factors are being overweight or
obese, not being physically active, usage of tobacco and alcohol, excess salt intake, lack of
potassium in the diet, and chronic stress. Uncontrollable risk factors include age, gender, race,
and family history.

Prehypertension

Systolic blood pressure (BP) of less than 140 mm Hg and diastolic BP of less than 90 mm
Hg were previously considered normal. However, there were some evidence that even BP in the
high reference range was associated with an increased risk of cardiovascular disease. This new
category is termed as prehypertension which is a continuum to hypertension and is a risk factor
for cardiovascular disease (Suri & Qureshi, 2006). Prehypertension is defined as a systolic and/or
diastolic blood pressure at the 90th percentile but less than the 95th percentile depending on
gender, age, and height. Several longitudinal studies state that blood pressure levels follow with
age (Collier & Landram, 2012).

It is characterized by a slightly above normal level and most likely to develop to

hypertension unless people change their lifestyle (Mayo Clinic Staff, 2018). Persons who are
prehypertensive have higher cardiovascular risk and the only thing (Collier & Landram, 2012)that
could prevent it from escalating to the point is to have a comprehensive lifestyle change to reduce
the risk of developing hypertension (Habib et, al., 2015).

Prehypertension is further classified as having a systolic blood pressure between 120 and
139 mmHg and/or diastolic pressures between 80 and 89 mmHg. Prehypertension is associated
with ~3-fold greater likelihood of developing hypertension, and roughly twice the number of
cardiovascular events, than BP < 120/80 mmHg. When compared with normotensive individuals,
prehypertensive individuals are more likely to be overweight and obese, to have other
cardiovascular risk factors, to progress to established hypertension, and to experience premature
clinical cardiovascular disease. The major unresolved issue is the appropriate management of
such patients. Lifestyle modification is recommended for all patients with prehypertension as it
effectively reduces rate of cardiovascular events. Present pharmacological therapy is indicated
for some patients with prehypertension who have specific comorbidities, including diabetes
mellitus, chronic kidney disease, and coronary artery disease (Gupta et, al., 2012).

Drug therapy for prehypertension is not yet recommended, except for individuals with
diabetes, chronic kidney disease, and perhaps known coronary artery disease, because of short-
term cost considerations and unproven long-term benefits. (Elliot et al., 2007).

Epidemiologic data have established a continuous relationship between vascular risk and
blood pressure that extends down to levels as low as 115/75 mmHg, emphasizing the lack of a
critical threshold value that defines 'high' blood pressure. Acknowledging the graded and
continuous nature of the relations of blood pressure to vascular risk, the Seventh Report of the
Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood
Pressure (JNC VII) introduced the new category 'prehypertension' to describe people with a
systolic blood pressure between 120 and 139 mmHg and/or a diastolic blood pressure between
80 and 89 mmHg. It is estimated that 31% of the US population (about 70 million) has
prehypertension. The risk of cardiovascular disease within this large prehypertensive population
is however not uniform, and increases with a rising concomitant burden of other vascular risk
factors. Accordingly, a strategy of estimating global cardiovascular risk (by applying standardized
risk prediction algorithms) and adjusting the intensity of blood pressure lowering (and reduction
of other risk factors) to the absolute risk of cardiovascular disease is desirable in prehypertensive
individuals. Adopting a healthier lifestyle is a critical component of the therapeutic approach to
prehypertension. (Atilla et al., 2008).

From 2005 to 2006, about 3 out of 8 adults in the United States had blood pressure of 120
to 139/80 to 89 mmHg and about 1 out of 8 adults had blood pressure of 130 to 139/85 to 89
mmHg which indicates high normal blood pressure or stage 2 prehypertension. Stage 2
prehypertension progresses to hypertension at a rate of approximately 8% to 14% yearly (Egan
et, al., 2010).

According to Redwine and Daniels (2012), young adults (20-30 years old) and students
were at higher risk for prehypertension than the general population of youth. In the Philippines,
13.9% are considered prehypertensive, which is almost 1 out of 7 young adults (Pengpid et, al.,
2014). In addition (Pletcher et al., 2008), stated that prehypertension is common in young
individuals and is associated with coronary atherosclerosis after more or less 20 years later in
life. Among the participants, 18% who are prehypertensive were usually male, black, overweight
and of lower socioeconomic status. Persons who are prehypertensive have higher cardiovascular
risk and the only thing that could prevent it from escalating to the point is to have a comprehensive
lifestyle change to reduce the risk of developing hypertension (Habib et al., 2015). This is
supported by another study which concluded that in young adults with elevated blood pressure,
stage 1 and stage 2 hypertension had a significantly higher risk of cardiovascular disease. The
study used the 2017 American College of Cardiology (ACC)/American Heart Association (AHA)
BP guideline (Yano et al., 2018).

Factors associated with Prehypertension

Factors affecting elevated blood pressure include excess sodium intake, excess body
weight, inadequate intake of fruits and vegetables, excess alcohol intake, and reduced physical
activity. At least 122 million Americans are either obese or overweight which is a major risk factor
for prehypertension and hypertension (Guo et al., 2011). Females consume sodium beyond the
daily recommendation while men consume sodium twice as much as the daily recommendation.
Less than 20% of Americans engage in regular physical exercise and less than 25% consume
the adequate amount of fruits and vegetables. A mortality study in 2012 states that 90% of
individuals with prehypertension involves conditions associated with increased cardiovascular
risks. This includes dyslipidemias, abdominal obesity, cigarette smoking, and hyperinsulinemia
(Collier and Landram, 2012).

Another study validates that alcohol consumption increases blood pressure; other
common stressors, such as work and post-graduation plans, were also shown to increase blood
pressure in the subjects that were studied. In addition to validating these previously conducted
studies, the researchers also found that longer commute times are correlated with higher blood
pressure (Beaujon & Mooney, 2017).

There is a significant association between BMI and smoking with blood pressure both
related to an increased BP. Moreover, women have lower mean blood pressure compared to men
and having first-degree history of hypertension or cardiovascular disease is associated with
increased blood pressure (Alhawari et al., 2018)

Katona et al (2011) studied the factors affecting hypertension among adolescents, 10,000
participated aged between 15 and 18 years of age. In their findings, BMI was shown to have a
critical influence on hypertension, causing changes in both systolic and diastolic blood pressure
levels, a unit increase in BMI caused the systolic BP to increase by 1.17 mm Hg, while diastolic
BP rose by 0.75 mm Hg With boys’ systolic BP being higher by 10mmhg compared to girls

Katona, É., Zrínyi, M., Komonyi, É., Lengyel, S., Paragh, G., Zatik, J., . . . Páll, D. (2011).
Factors influencing adolescent blood pressure: The debrecen hypertension study. Kidney &
Blood Pressure Research, 34(3), 188-95. doi:http://dx.doi.org/10.1159/000326115
 According to Redwine and Daniels (2012), young adults (20-30 years old) and students
were at higher risk for prehypertension than the general youth population. In the Philippines,
13.9% are prehypertensive, that is around 1 out of 7 young adults (Pengpid et al., 2014).

Gender

Many studies done on both humans and animals show that the prevalence of hypertension
varies among males and females due to both biological and behavioral factors, with males having
substantially higher rates of both hypertension and prehypertension, the biological factors leading
to this are not clearly understood and they include sex hormones and chromosomal differences
(Agho et al, 2018)

Agho, K. E., ⨯ Uchechukwu, L. O., ⨯ Osita, K. E., Ghimire, P. R., Chitekwe, S., & Ogbo, F. A.
(2018). Gender differences in factors associated with prehypertension and hypertension in
nepal: A nationwide survey. PLoS One, 13(9) doi:http://dx.doi.org/10.1371/-
journal.pone.0203278

A study at King Fahd University in Dammam City stated that higher rates of hypertension
are among male students having 13.8% systolic and 3.7% diastolic hypertension (Baig et al.,
2015). In a different study, hypertension was observed among college students in Gondar,
Ethiopia. 610 college students were screened where 453 (74.4%) were male and 157 (25.6%)
were female. The prevalence of hypertension was 7.7%. Higher rates of hypertension were
observed among those who are male, overweight, and those who have a sleep duration of ≤5
hours. Increasing awareness and early screening for the disease are some of the preventive
measures for hypertension (Tadesse & Alemu, 2014).

A national survey conducted by El Bcheraoui et al., reported a prevalence of 13.34%

among the age group 15-24 years old. Another study conducted among university students in
Dammam, Saudi Arabia showed a prevalence of 13.8% for systolic hypertension and 3.7% for
diastolic hypertension. Furthermore, a study conducted in Kampala, Uganda among medical
students reported a similar hypertension prevalence of 14% (AlWabel et al., 2018).

Age

In many countries across the world, hypertension is becoming increasingly more prevalent
among pediatric age group in an alarming manner especially with the increasing number of
obesity cases, this might be related to the changes in lifestyle practices associated with the
accelerated socioeconomic growth such as lack of physical activity and unhealthy diet that is
commonly seen among today’s younger generations (Lee,2014).
Lee, C. G. (2014). The emerging epidemic of hypertension in asian children and adolescents.
Current Hypertension Reports, 16(12), 1-495. doi:http://dx.doi.org/10.1007/s11906-014-0495-z

A cross sectional study was done in Nigeria among adolescents aged 10-19years in
secondary schools, around 6.3% of the student were hypertensive with 5.0% falling meeting the
criteria for prehypertension, the researchers concluded that adolescents who are apparently
healthy can be hypertensive and stressed the need for hypertension screening among this age
group (Elias, 2018).
Elias, E. C., Chukwuka, J. O., Ebenebe, J. C., Igwe, W. C., & Ifeoma, E. (2018). Hypertension
and prehypertension among adolescents attending secondary schools in urban area of south-
east, nigeria. The Pan African Medical Journal, 31 doi:http://dx.doi.org/10.11604/-
pamj.2018.31.145.15994

In a study by Baig et al., 7.5% of the students had hypertension where 2.6% had systolic and
6.3% had diastolic hypertension. On the other hand, there is a very high prevalence of
hypertension among adults. However, awareness, treatment and control of hypertension is very
low. Risk factors for hypertension includes being unable to read and write, lack of fruits in the diet,
being physically inactive, being overweight and absence of physical inactivity (Gebrihet et al.,
2017). In the United States, half of the adults who are older than 18 experiences prehypertension
or hypertension (WebMD, 2019).

Body Mass Index

Body Mass Index (BMI) is a ratio of weight to height calculated by dividing a person's
weight in kilograms and the square of the height in meters. This parameter is oftentimes used to
assess a person’s body weight and height proportion. Persons with a BMI of 25-29.99 can be
considered overweight; thus, there is more body weight in proportion to height. A BMI ranging
from 30 or above is considered obese which means there is already a large amount of body fat
in relation to the height. Higher BMI imposes risks of diseases which include heart disease, high
blood pressure, type 2 diabetes, gallstones, osteoarthritis, sleep apnea, and certain cancers
(National Heart, Lung, and Blood Institute, 2019).

BMI as a non-invasive and economic measure of body fat had been utilized in a
widespread level which increases the availability of population data and allowed health
professionals to correlate it to different subgroups of population. However, BMI measures weight
as a whole regardless if the weight is primarily on fat, muscle, or bone mass. In order to acquire
accurate data, certain limitations should be considered in using this measurement such as for
those highly trained athletes, muscularly-defined individuals, people with muscle wasting
disorder, older persons who tend have more body fat than younger adults, and other examples
that fall in the criteria (CDC, 2011).
 Overweight refers to individuals having a body mass index (BMI) of 25 to 30 kg/m2 and
obesity refers to having a body mass index of greater than 30 kg/m2. There was a statistically
significant elevation in the mean systolic and diastolic blood pressure with age and body mass
index. In overweight and obese individuals, the mean systolic blood pressure (SBP) and diastolic
blood pressure (DBP) were significantly higher in male individuals. Results showed that 56.8% of
males and 35.8% of females were considered prehypertensive. The body mass index did not
increase with regards to increasing age (Israeli et al., 2006).

To further establish its connection with hypertension, a study conducted in 1.7 million
China adults with regards to association of body mass index and blood pressure had proven a
positive correlation between these two. As the body mass index increases, risk of acquiring higher
blood pressure to increases. Thus, as a conclusion, hypertension is highly prevalent in obese
populations (Linderman et al., 2018).

Family History

Heredity is the process which explains why a trait from a family member can be passed
from generation to generation through genes. With this, genetic factors contribute a significant
impact in acquisition of diseases such as high blood pressure, heart disease, and other related
conditions. The risk factor would exacerbate if combined with unhealthy lifestyle choices (CDC,
2019b). Family Health History is an essential tool in keeping records of the health conditions a
family had in the past. This comprehensive guide of the possible risks an individual is likely to
acquire can help generate greater chances of preventing a certain disease.

A non-modifiable risk factor includes hypertension. In a study conducted among Sri

Lankan adults regarding the influence of family history hypertension on disease prevalence and
associated metabolic risk factors, it was found out that those individuals with a family history of
hypertension tend to have a higher prevalence than those who do not.

Physical activity

A comprehensive amount of evidences support the effect of physical activity and exercise
interventions on the blood pressure of normotensive and prehypertensive participants. A study
concluded that physical activity has a significant role towards hypertension prevention (Diaz &
Shimbo, 2013).

Diet

One important strategy of cardiovascular health promotion and modification of blood

pressure is through dietary approach. Dietary patterns include DASH Diet and Mediterranean
Diet. DASH stands for Dietary Approaches to Stop Hypertension pattern. This promotes a diet
rich in fruits, vegetables, low-fat dairy product, and reduced saturated and total fat. In the Optimal
Macro-Nutrient Intake to Prevent Heart Disease or OmniHeart, substitution of protein instead of
carbohydrates additionally lowers blood pressure. The Mediterranean diet is similar to DASH diet,
except that it is composed of mono-saturated fat from nuts, seeds, or olive oil. Evidences taken
as a whole suggest the blood pressure lowering capacity of the aforementioned dietary patterns.
 Effective clinical and public health interventions that immerse the people towards a well
structured community organizing lead to a sustained dietary changes thus, creating a healthier
and environment. As a summary, there is a correlation between hypertension and diet (Bazzano
et, al., 2013).

Stress

A cross-sectional study conducted in China tackled about the effects of psychological

stress on hypertension in middle-aged Chinese individuals. The study concluded that stress
experienced in work or home or collectively known as psychological stress is associated with
greater risk of hypertension among the said population. In addition, the psychological stress
affected more women over men; however, this gender difference is still open for scientific
exploration. Stress may not directly cause hypertension, however it can cause repetitive blood
elevations. When another risk factor is paired with stress, there will be likely a synergistic effect
on the development of hypertension.

Puddey et al (2019) confirmed the alcohol related hypertension is increases the risk for
cardiovascular diseases and is related to the vasoconstrictor 20-HETE and oxidative stress

Puddey, I. B., Mori, T. A., Barden, A. E., & Beilin, L. J. (2019). Alcohol and Hypertension—New
insights and lingering controversies. Current Hypertension Reports, 21(10), 1-10.
doi:http://dx.doi.org/10.1007/s11906-019-0984-1

Alcohol Intake

Excessive alcohol consumption is associated with elevated blood pressure which further
leads to hypertension. In the Reasons for Geographic and Racial Differences in Stroke study, a
national cohort on racial differences stated that heavy alcohol consumption is significantly
associated with systolic blood pressure and a higher prevalence of hypertension. This study also
found out that the association of alcohol consumption and hypertension is stronger among
diabetic individuals (Bazzano et al., 2013).

Consumption of less than 30g of alcohol a day or approximately two drinks for men and
less than 15g of alcohol or approximately one drink for women do not generally increase blood
pressure. However, larger intake of alcohol has a dose-related effect on blood pressure. Use of
tobacco or cigarette smoking is a risk factor for cardiovascular disease which increases blood
pressure (Collier and Landram, 2012). Tobacco intake is also associated with hypertension (Guo
et al., 2011).
OBJECTIVES

GENERAL OBJECTIVES

The study aims to determine prehypertension and associated factors among university students
in Davao City.

SPECIFIC OBJECTIVES

This study sought to determine the following:

1. The demographic profile of the college students in terms of:

a. Age
b. Gender

2. The personal and social history of students in terms of:

a. Lifestyle
i. Smoking
ii. Drinking
b. Family history

3. The health status of the students in terms of:

a. BMI
b. Blood Pressure

4. The factors contributing to the development of prehypertension

a. Weight
b. Physical activity
c. Salt intake
d. Tobacco use
e. Alcohol use
f. Chronic stress

THEORETICAL FRAMEWORK

Prehypertension refers to a slight increase in blood pressure level and is common in young
adults. It is not a disease but a warning sign that a possibility of acquiring hypertension lies ahead.
Young adults and students who are obese or over-weight, have less physical activities, high salt
intake, tobacco and alcohol users and under a lot of chronic stress are more prone to develop
prehypertension. Personal and social profile of students must be considered such as age, gender,
personal and family medical history, BMI, and blood pressure levels (CDC, 2014).

SIGNIFICANCE OF THE STUDY

This study will be able to detect the prevalence of prehypertension among college
students before it possibly progresses to hypertension. It is important to monitor an individual’s
blood pressure since hypertension is a major risk factor for more serious diseases such as heart
disease and stroke. This study will help students detect early hypertension, so they can consult a
doctor as soon as possible to alleviate the risk of developing hypertension. Furthermore, this
study will raise awareness on hypertension, its causes, and associated risks.

SCOPE AND LIMITATIONS

The study will focus on identifying the prevalence prehypertension among college students
in Davao City and the risks factors that contributes to its development. Thus, students who are
diagnosed with hypertension is excluded. The information that will be obtained from the
respondents will include age, gender, lifestyle, medical history, diabetes, and other hereditary
illnesses of the family. Weight, physical activities, salt intake, tobacco and alcohol uses, and
chronic stress will also be included. Other parameters to be measured from the respondents
include BMI and Blood Pressure.

The inclusion criteria for research respondents will be the following;

1. Must be a resident or currently living in Davao City
2. Must be a college or university student
3. Male or female
4. 18-23 years’ old

The said data will be collected by the researchers using devices such as sphygmomanometer
and survey questionnaires.
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List of Figures:
Figure 1. Guideline Date Retrieved: October 3, 2019 Retrieved from:
https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-
etc/Guidelines/2017/Guidelines_Made_Simple_2017_HBP.pdf?fbclid=IwAR111e6N9Whzj
 AI8b9P-g3khToLntCxWDeHYjwga9RnLVquYJBSkHFz3wIU
Figure 2. Guideline Date Retrieved: October 3, 2019 Retrieved from:
https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-
etc/Guidelines/2017/Guidelines_Made_Simple_2017_HBP.pdf?fbclid=IwAR111e6N9Whzj
AI8b9P-g3khToLntCxWDeHYjwga9RnLVquYJBSkHFz3wIU
Figure 3. Date Retrieved: October 3, 2019. Retrieved from:
https://www.accp.com/docs/bookstore/psap/p2019b1_sample.pdf
Figure 4. Philippines in Figures 2018. (2019). [ebook] Philippine Statistics Office, p.48. Available
at: https://psa.gov.ph/sites/default/files/PIF%202018.pdf [Accessed 2 Oct. 2019].