PLOS Global Public Health · 6 authors, 6 centres
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This cross-sectional study of 806 adolescents aged 15–19 years in eastern Nepal found that 20.8% had prehypertension and 7.1% had hypertension. Older age, male sex, Janjati ethnicity, and obesity were significant predictors of prehypertension. The findings highlight the need for school-based interventions targeting modifiable risk factors like smoking, alcohol use, and poor diet to reduce future cardiovascular disease burden.
**Background:** Prehypertension is a transitional state between normal blood pressure and hypertension. Adolescent prehypertension strongly predicts adult hypertension and cardiovascular events. Despite rising non-communicable disease burden in Nepal, data on prehypertension among Nepali adolescents are scarce. This study aimed to assess the prevalence and predictors of prehypertension among older adolescents in eastern Nepal.
**Methods:** A cross-sectional study was conducted from March 2017 to February 2018 among grade 11 and 12 students in three eastern terai districts of Nepal: Jhapa, Morang, and Sunsari. Multistage stratified proportionate random sampling was used to select 12 schools (4 per district). Sample size was calculated based on an earlier Nepali cohort reporting 11.6% prehypertension prevalence, yielding a final sample of 806 after adjusting for 10% non-response. A semi-structured questionnaire adapted from the WHO STEPS instrument was administered via face-to-face interviews. Anthropometric measurements (height, weight, waist and hip circumference) and blood pressure (3 readings, mean of 2nd and 3rd recorded) were taken by the investigator. Prehypertension was defined per the Fourth Report (NHBPEP) for those <18 years and JNC 7 criteria for those ≥18 years. BMI was classified using CDC growth charts; central obesity was defined as waist-height ratio ≥0.5. Multivariable binary logistic regression was used to identify predictors.
**Key Results:** Among 806 participants (57.1% female, mean age 17.3±0.9 years), prehypertension prevalence was 20.8% (24.6% in males, 18.0% in females). Hypertension was found in 7.1% (9.2% males, 5.4% females). Obesity (BMI ≥95th percentile) was present in 6.3%, and central obesity in 17.7%. Smoking was reported by 22.0%, alcohol use by 37.3%, and only 3.2% consumed adequate fruits and vegetables. In the final multivariable model, significant predictors of prehypertension were: age ≥18 years (AOR 2.27, 95% CI 1.59–3.26, p<0.001), male sex (AOR 1.51, 95% CI 1.05–2.17, p=0.027), Janjati ethnicity (AOR 1.76, 95% CI 1.22–2.56, p=0.003), and obesity (AOR 2.32, 95% CI 1.22–4.43, p=0.011). Eating outside the home (AOR 1.49, 95% CI 0.94–2.35, p=0.087) and family history of hypertension (AOR 1.37, 95% CI 0.94–2.00, p=0.103) were retained in the model but did not reach statistical significance. BMI, waist-hip ratio, and waist-height ratio all showed significant positive correlations with systolic and diastolic blood pressure (p<0.01).
**Clinical Implications:** One in five adolescents in this study had prehypertension, and nearly one in 14 had hypertension — rates higher than those reported in a Nepali cohort from 2006–2008, suggesting a rising trend. The strong association with obesity (2.3-fold increased odds) and the presence of modifiable risk factors (smoking, alcohol, poor diet, eating out) indicate clear targets for intervention. School-based programs addressing physical activity, nutrition, and tobacco/alcohol use could help reduce the future burden of cardiovascular disease. The ethnic variation (higher risk among Janjati) warrants further investigation into genetic and sociocultural determinants. Limitations include single-visit blood pressure measurement (potential overestimation) and the cross-sectional design, which precludes causal inference. Generalizability to other regions of Nepal may be limited.