High Prevalence of Prehypertension and its Association with Modifiable Risk Factors: Findings of Household STEPS Survey from Urban Puducherry, South India

Sitanshu Sekahr Kar, Kalaiselvi Selvaraj, Gomathi Ramaswamy, K. C. Premarajan, Ganesh Kumar Saya, Vinodhkumar Kalidoss


Background: Prehypertension increases the likelihood of hypertension, cardiovascular diseases, and renal failure, and it is amenable to control if it is detected early. The burden of prehypertension prevalent in the community is not much explored. This study aimed to estimate the prevalence and to identify the socio‑behavioral and dietary factors related to prehypertension in South India.

Methods: A community‑based cross‑sectional study was carried out where data related to socio‑demographic status, substance use, dietary patterns, physical activity, and associated comorbidities were assessed using the WHO STEPwise survey tool. Adults aged >=18 years who were not previously diagnosed and treated for hypertension were assessed for prehypertension. Prevalence of prehypertension is reported as percentage with 95% CI. Association was reported as adjusted prevalence ratio obtained through multivariable log binomial regression adjusted for potential confounders.

Results: Among 2399 participants, 2213 underwent screening. Among 2213 adults, 810 (36.6%, 95% CI: 34.6–38.6%) were in the prehypertension range. The adjusted prevalence for prehypertension was 36.2% among males and 37.2% among females, respectively. Being in the age group of 45–54 years aPR-1.36, body mass index (BMI) >23 Kg/m2 aPR-1.25, consumption of more than 6 grams of salt per day aPR-1.15 times were more likely to be associated with prehypertension. The comorbid conditions such as diabetes are less likely to be associated with prehypertension aPR-0.54 (0.41–0.72).

Conclusions: This community‑based surveillance showed 36% of prehypertension among adults which would have been missed if we were to follow the routine cares such as opportunistic and high‑risk‑based screening. Since prehypertension increases the risk for various end organ failures, there is an impending need to focus on screening and promote healthy lifestyles.


Cardiovascular diseases; early diagnosis; epidemiology; mass screening; prehypertension; public health surveillance

Full Text:



World Health Organization. Global Status Report on

noncommunicable diseases 2014 [Internet]. Switzerland: 2014.

Available from: http://www.who.int/about/licensing/copyright_


Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D.

Assessment of frequency of progression to hypertension in

non‑hypertensive participants in the Framingham Heart Study:

A cohort study. Lancet 2001;358:1682‑6.

Amachandran R, Asan S V, Artin M, Arson GL, Eip RPL,

Ane J, et al. Impact of high‑normal blood pressure on the risk of

cardiovascular disease. N Engl J Med 2001;345:1291‑7.

Nhlbi. Seventh Report of the Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood

Pressure (JNC7). Available from: https://www.nhlbi.nih.gov/files/

docs/guidelines/jnc7full.pdf. [Last cited on 2017 Mar 31].

Ahmad F, Sharma N, Sharma SP. Prehypertension: A necessity!!!

Med J Armed Forces India 2005;61:405.

Assadi F. Relation of left ventricular hypertrophy to

microalbuminuria and C‑reactive protein in children and

adolescents with essential hypertension. Pediatr Cardiol


Bajpai JK, Sahay AP, Agarwal AK, De AK, Garg B, Goel A.

Impact of prehypertension on left ventricular structure, function

and geometry. J Clin Diagnostic Res 2014;8:7‑10.

Saxena Y, Gupta R, Moinuddin A, Narwal R. Blood pressure

reduction following accumulated physical activity in

prehypertensive. J Fam Med Prim Care 2016;5:349.

Chen ST, Maruthur NM, Appel LJ. The effect of dietary patterns

on estimated coronary heart disease risk: Results from the

Dietary Approaches to Stop Hypertension (DASH) trial. Circ

Cardiovasc Qual Outcomes 2010;3:484‑9.

Hageman PA, Pullen CH, Hertzog M, Boeckner LS.

Effectiveness of tailored lifestyle interventions, using web‑based

and print‑mail, for reducing blood pressure among rural women

with prehypertension: Main results of the Wellness for Women:

DASHing towards Health clinical trial. Int J Behav Nutr Phys

Act 2014;11:148.

Maruthur NM, Wang NY, Appel LJ. Lifestyle interventions

reduce coronary heart disease risk: Results from the PREMIER

Trial. Circulation 2009;119:2026‑31.

Hughes JW, Fresco DM, Myerscough R, van Dulmen MH,

Carlson LE, Josephson R. Randomized controlled trial of

mindfulness‑based stress reduction for prehypertension.

Psychosom Med 2013;75:721‑8.

Prabhakaran D, Shah P, Chaturvedi V, Ramakrishnan L,

Manhapra A, Srinath Reddy K, et al. Cardiovascular risk factor

prevalence among men in a large industry of northern India. Natl

Med J India 2005;18:59‑65.

Ray S, Kulkarni B, Sreenivas A. Prevalence of prehypertension

in young military adults & its association with overweight &

dyslipidaemia. Indian J Med Res 2011;134:162‑7.

Ravi M, Ashok N, Renuka M. Prevalence of prehypertension in

a rural district of Southern India. Int J Prev Med 2015;6:84.

Premkumar R, Pothen J, Rima J, Arole S. Prevalence of

hypertension and prehypertension in a community‑based primary

health care program villages at central India. Indian Heart J


Chaudhry K, Diwan SK, Mahajan SN. Prehypertension in young

females, where do they stand? Indian Heart J 2012;64:280‑3.

Moinuddin A, Gupta R, Saxena Y. Assessment of anthropometric

indices, salt intake and physical activity in the aetiology of

prehypertension. J Clin Diagnostic Res 2016;10:CC11‑4.

Math MV. Prehypertension associated with dyslipidaemia

in young adults ‑ life‑style & telomeres. Indian J Med Res


Kar SS, Kalaiselvi S, Archana R, Saya GK, Premarajan KC. Is

rule of halves still an occurrence in South India: Findings from

community‑based survey in a selected urban area of Puducherry.

J Postgrad Med 2017;63:232‑6.

International Institute for Population Sciences. National Family

Health Survey 2015‑16, India Report [Internet]. Mumbai: 2016.

Available from: http://www.rchiips.org/nfhs.

WHO | STEPwise approach to surveillance (STEPS). WHO

[Internet] 2015. Available from: http://www.who.int/chp/steps/

en/. [Last cited on 2017 Mar 11].

World Health Organization. Physical status: The use of and

interpretation of anthropometry, report of a WHO expert

committee [Internet]. Geneva: World Health Organization: 1995.

Available from: http://apps.who.int/iris/handle/10665/37003.

EpiData Software ‑ http://www.epidata.dk [Internet]. Available

from: http://epidata.dk/. [Last cited on 2017 Mar 11].

Data Analysis and Statistical Software | Stata [Internet]. Available

from: http://www.stata.com/. [Last cited on 2017 Mar 31].

Al‑Majed HT, Sadek AA. Pre‑hypertension and hypertension

in college students in Kuwait: A neglected issue. J Family

Community Med 2012;19:105‑12.

Majumdar A, Chinnakali P, Vinayagamoorthy V, Daya PA,

Shidam UG, Roy G. Opportunistic screening for hypertension

and selected cardiovascular risk factors among adults attending

a primary health center in Puducherry, India. Int J Prev Med


Yadav S, Boddula R, Genitta G, Bhatia V, Bansal B, Kongara S,

et al. Prevalence & risk factors of pre‑hypertension &

hypertension in an affluent north Indian population. Indian J

Med Res 2008;128:712‑20.

Khanam MA, Lindeboom W, Razzaque A, Niessen L,

Milton AH. Prevalence and determinants of pre‑hypertension

and hypertension among the adults in rural Bangladesh: Findings

from a community‑based study. BMC Public Health 2015;15:203.

Okwuonu C, Ngoka S, Uwanurochi K, Mbanaso A, Chimezie O,

Eze T. Towards prevention of hypertension in Nigeria: A study

of prehypertension and its associations among apparently

healthy adults in Umuahia, South‑East Nigeria. Int J Prev Med


Al‑Shahrani AM, Al‑Khaldi YM. Experience of the health

promotion clinics in Aseer region, Saudi Arabia. J Family

Community Med 2011;18:130‑4.

Seo HJ, Kim SG, Kim CS, Chang YK, Park IG. The incidence

and risk factors of hypertension that developed in a male‑workers’

cohort for 3 years. J Prev Med Public Health 2006;39:229‑34.