Correlation study of socio-demographic factors like gender, age, body mass index and some cardiovascular parameters in hypertensive subjects of Yenagoa, Bayelsa state, Nigeria

Correlation of socio-demographic factors with CV parameters in hypertension

Ayebatonbra Egbejimi Michael
Department of Human Physiology, Faculty of Basic Medical Sciences,
Niger Delta University,
Bayelsa State, Nigeria.
Sunday Ogbu Ojeka
Department of Human Physiology, Faculty of Basic Medical Sciences, College of Health Science,
University of Port Harcourt,
Rivers State, Nigeria.
https://orcid.org/0000-0001-8454-7326
Zigabelbari Zabbey Victor
Department of Human Physiology, Faculty of Basic Medical Sciences, College of Health Science,
University of Port Harcourt,
Rivers State, Nigeria.

Article History
Submitted : 2021-07-28
Revised : 2021-11-02
Accepted : 2021-11-02
Online : 2021-11-20
Print : 2021-11-20

DOI via Crossref 10.23921/amp.2021v5i2.00046

Copyright © 2021. Quench Academy of Medical Education and Research (QAMER)
Creative Commons License
This article is licensed under a Creative Commons Attribution 4.0 International License.

Disclosure of financial and non-financial relationships and activities: Authors have declared that no conflicting interests exist.

Scan QR Code

Full text

Abstract

Hypertension is defined as a sustained elevated arterial pressure to a level that places the patient at increased risk of organ damage. It is a non-communicable disease which constitutes a public health importance. Its risk factors include advancing age, high salt intake, excessive alcohol consumption and stress. This study was performed to determine the correlation between some socio-demographic factors like gender, age, body mass index (BMI) and some cardiovascular parameters in hypertensive patients of Yenagoa, Bayelsa State, Nigeria. The study was carried out with 400 hypertensive subjects, whose blood pressures were determined using palpatory and auscultatory methods. The gender, age and body mass index of the subjects were also determined. Statistical analysis was done using Z-statistics. We found a significant positive relationship between the age and cardiovascular parameters. Gender and BMI were found to have an insignificant positive correlation with the cardiovascular parameters. The study demonstrated that body mass index, age and gender are closely associated with cardiovascular parameters, though the degree of correlation differed. The risk of hypertension is therefore expected to be higher among the aged and populations who are overweight or obese.

Keywords: Age of onset, Blood pressure, Body height, Body Mass Index, Hypertension, Systolic pressure

How to cite: Michael AE, Ojeka SO, Victor ZZ. Correlation study of socio-demographic factors like gender, age, body mass index and some cardiovascular parameters in hypertensive subjects of Yenagoa, Bayelsa state, Nigeria. Ann Med Physiol. 2021 Apr-May;5(2):7-12. doi: 10.23921/amp.2021v5i2.00046

Introduction

Hypertension, often known as high blood pressure, is a well-known chronic medical illness and is described as a persistent rise in arterial pressure (140/90 mm Hg or higher) to a point where the patient is at risk of organ damage. Hypertension is one of the most frequent life-threatening non-communicable diseases affecting about 1 billion people all over the world and contributing to about 7.6 million premature (ages between 30 and 69 years) deaths (about 13% of deaths worldwide), 54% of strokes and 47% of cardiovascular diseases [1, 2, 3, 4, 5].

Primary (essential) hypertension and secondary hypertension are two major classes of high blood pressure [6]. Primary hypertension is defined as high blood pressure caused by non-specific lifestyle and genetic variables in 90 to 95 percent of all known cases. Secondary high blood pressure occurs in 5–10% of instances and is caused by an identifiable cause, such as chronic renal disease, narrowing of the kidney arteries, an endocrine problem, or the use of birth control pills [6, 7].

In adults, the systolic and diastolic pressures, which are the maximum and minimum pressures developed in the arteries, at rest are within the range of 110–140 mmHg and 60–90 mmHg respectively [8, 9]. However, different numbers apply to children [10].

Obesity, age, stress, high salt intake, cigarette use, physical inactivity, dietary variables, alcohol usage, and genetics are all key risk factors, according to previous studies [11].

Some drugs and lifestyle modifications can help to control blood pressure and reduce the risk of health issues. Weight loss, physical activity, reduced salt intake, reduced alcohol intake, and a balanced diet are all examples of lifestyle modifications [6]. Medications are used when lifestyle improvements are insufficient to entirely decrease the blood pressure. The use of drugs to treat moderately high arterial blood pressure (defined as >160/100 mmHg) has been linked to a longer life expectancy [12].

The aim of this study was therefore to determine the influence of advancing age, gender and BMI on cardiovascular parameters amongst known hypertensives in Yenagoa, Bayelsa State, Nigeria.

Materials and methods

The study was carried out in the Cardiology Clinics where blood pressure checks and care for hypertension cases are provided routinely in the Niger Delta University Teaching Hospital (NDUTH), Okolobiri. The NDUTH is a Bayelsa State Government-owned teaching hospital established in 2007. It is situated in Okolobiri, in Yenagoa local government area (YELGA) of Bayelsa State.

The target population for this study consisted of all the hypertensive patients attending the Cardiology Clinics for medical care and routine check-up. Two groups of individuals were used for this study—those with normal blood pressure (Normotensives) and those with elevated blood pressure (Hypertensives).

The sample size for this study was obtained using the formula as described by a group of researchers [13].

N=Z2Pq/d2

Where;
N is the minimum sample size
Z is a constant at 95% confidence level for 2-tailed study (1.96) and significance level is 0.05
P is the immunization coverage for Bayelsa state (51.5%)
q is 1-p
d is the absolute precision required in percentage between the population and the sample, at 95%CI, which we set as 5%

Substituting;
N=1.962 × 0.515 × (1-0.515)/0.052=384 ≈400

Eight hundred (800) subjects (Hypertensive n=400 and Normotensive n=400) were randomly selected.

The Group 1 subjects were normotensive patients attending the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Bayelsa State. This group served as the control group. Group 2 subjects were hypertensive patients attending the Cardiology Clinic of Niger Delta University Teaching Hospital (NDUTH) Okolobiri, Bayelsa State.

Data was collected based on a checklist that collects the socio-demographic information, BMI of the patients and their cardiovascular parameters recorded in the laboratory using standard techniques.

The blood pressure parameters were measured manually using stethoscope (Littmann, England) and standard mercury sphygmomanometer (Fisher Scientific, England). The following blood pressure parameters were noted: systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) and mean arterial pressure (MAP).

The data was analyzed using SPSS version 20.0 (IBM SPSS, Chicago, USA).

This study has been approved by the ethics and research units of both the University of Port Harcourt (Ethical Clearance Number: UPH/CEREMAD/REC/MM67/002) and Niger Delta University Teaching Hospital Okolobiri and have therefore been performed in accordance with the ethical standards laid down by both Universities.

Inclusion and exclusion criteria

The inclusion criteria included both normotensive and hypertensive patients attending the Niger Delta University Teaching Hospital, Okolobiri. Normotensive and hypertensive patients attending other health facilities in Bayelsa State were excluded from the study. Also, patients younger than 18 years of age were excluded from the study.

Results

Table 1: Socio-demographic characteristics of the study population
Variables Normotensive (N=400) n(%) Hypertensive (N=400) n(%)
Gender Male 207(51.4) 196(49.0)
Female 193(48.6) 204(51.0)
Age (Years) 18-35 307(76.7) 14(3.5)
36-55 83(20.8) 188(47.0)
>55 10(2.5) 198(49.5)
Marital status Single 242(60.5) 20(5.0)
Married 155(38.8) 336(84.0)
Divorced / Separated 3(0.8) 44(11.0)
Ethnicity Ijaw 249(62.2) 290(72.5)
Hausa 6(1.5) 10(2.5)
Igbo 63(15.8) 68(17.0)
Yoruba 33(8.3) 25(6.3)
Others 49(12.3) 7(1.8)
Religion Christian 370(92.5) 367(91.8)
Muslim 19(4.8) 31(7.8)
Others 11(2.8) 2(0.5)
Occupation Student 273(68.3) 3(0.8)
Civil Servant 127(31.8) 215(53.8)
Others 0(0.0) 182(45.5)
BMI class Normal 172(43.0) 34(8.5)
Overweight 192(48.0) 257(64.3)
Obese 36(9.0) 109(27.3)
Table 2: Gender and cardiovascular (CV) parameters of male and female hypertensive subjects in Yenagoa, Bayelsa State
CV parameters Male (n=196) Female (n=204) Z-test significance
SBP (mmHg) 134.45±16.73 133.44±14.39 0.28
DBP (mmHg) 85.82±12.78 83.56±10.46 0.24
PP (mmHg) 48.63±12.06 49.87±11.75 0.63
MAP (mmHg) 102.03±13.03 100.18±10.55 0.39
Table 3: Age and cardiovascular (CV) parameters of normotensive and hypertensive subjects in Yenagoa, Bayelsa State
CV parameters Normotensive (N=400) Hypertensive (N=400) Z-test significance
Age (Years) 30.05±9.27 55.82±12.24 0.01*
SBP (mmHg) 119.18±8.55 133.94±15.57 0.01*
DBP (mmHg) 74.98±6.38 84.67±11.69 0.01*
Pulse Pressure (mmHg) 44.20±8.06 49.27±11.90 0.01*
MAP (mmHg) 89.71±6.09 101.09±11.85 0.01*
Table 4: Body Mass Index (BMI) and cardiovascular parameters of male and female hypertensive subjects in Yenagoa, Bayelsa State
CV parameters Male (n=196) Female (n=204) Z-test significance
BMI (kg/m2) 28.23±2.78 28.74±2.80 0.27
SBP (mmHg) 134.45±16.73 133.44±14.39 0.28
DBP (mmHg) 85.82±12.78 83.56±10.46 0.24
PP (mmHg) 48.63±12.06 49.87±11.75 0.63
MAP (mmHg) 102.03±13.03 100.18±10.55 0.39

Discussion

Distribution of socio-demographic parameters

The socio-demographic characteristics of the study population are shown in Table 1. The results showed that normotensive males were more 207(51.4%) than females 193(48.6%) while females were found having hypertension 204 (51.0%) more than the males 196(49.0%). This result contradicts the study results obtained by other researchers [14], which found that men had a higher prevalence of hypertension than women. The result of this study may be due to the tradition of the respondents, as women tend to be more concerned with providing for the family than men do. Married couples were found to be more prone to hypertension in comparison to singles, divorced or separated. This observation may not be unconnected with the stress involved in maintaining a home. The Ijaw ethnicity was found to be predominantly more hypertensive compared to other ethnic groups. This may be because the study location is within the Ijaw ethnic region. Christians were found to be more hypertensive compared to other religious groups. Civil servants tend to develop hypertension more compared to students and other occupations. Finally, majority of the hypertensive subjects were found to be overweight.

Influence of gender on cardiovascular parameters of the hypertensive subjects

As observed from Table 1 and Table 2, majority of the hypertensive participants in this study were females 204 (51.0%), as against 196 (49.0%) of males, with female to male ratio of 1.04:1 (Table 1). This result is in conformity with earlier reports [15] where female participants were in the majority (55.26%). Fewer reports from Nigerian authors also got similar reports. Others [16, 17] reported that females were the majority of respondents with hypertension. This result however contradicts the outcome of the work done by other researchers [18] which observed the prevalence rates of hypertension to be generally higher in males than in females.

Influence of age on cardiovascular parameters of the hypertensive subjects

Results from our study revealed that the average age of the hypertensive participants was 55.82 ±12.24 years (Table 3). This means that the age range greater than 55 years was seen to be more prone to hypertension. Several studies have indicated that high BP is associated with age and this is connected with the process of modernization. Nowadays, high blood pressure is one of the risk factors for cardiovascular diseases, and the estimated 7.1 million deaths especially among middle, and old-age adults is due to high BP.

This result corroborates with that obtained by others [19], where the mean age of the hypertensive participants was found to be 52.3±10.1 years. This is higher than 35.66±8.2 years reported by others [20] in an earlier report among participants from Northern India.

Influence of BMI on cardiovascular parameters of the hypertensive subjects

Table 4 shows the body mass index (BMI) and cardiovascular parameters of male and female hypertensive subjects in the study population. The female subjects were found to be significantly older when compared to the male subjects. There was an increase in the values of the systolic, diastolic, pulse and mean arterial pressures between the male and female subjects with respect to their body mass indices. However this increase was found to be statistically insignificant.

Body mass index (BMI) is one of the most useful indices for obesity in adults. The relationship between excess weight and diseases has been recognized over time [21, 22]. Obesity has been particularly recognized as a major independent risk factor for cardiovascular diseases [23], diabetes mellitus, hypertension and hypercholesterolemia [24, 25]. This is true because increased body fat is accompanied by profound changes in the physiological and metabolic functions of the body, which are directly dependent on the degree of excess weight and on its distribution around the body. BMI has been found to be positively and independently associated with morbidity and mortality from hypertension, cardiovascular disease, type 2 diabetes mellitus, and other chronic diseases.

According to a group of researchers [26], the correlation analysis between BMI and BP showed significant positive correlations such that when the mean systolic and diastolic blood pressures among different BMI categories were evaluated, it was found that the mean systolic and diastolic blood pressures increased with increasing BMI from lowest BMI to the highest BMI category. Significant correlation of BMI with blood pressure was also found by others [27]. A positive association between BMI and BP has also been reported by other researchers [28]. Another group of researchers [29] has reported a positive association between increasing body mass index and blood pressure (BP) in populations. Also, according to others [14], the prevalence of hypertension significantly increased with the increase in BMI, such that among participants with a normal BMI, the prevalence of hypertension was 45% compared to 67% among overweight participants, 79% in obesity class I and II, and up to 87% among participants with obesity class III. The work carried out by a group of researchers on the relationship between BMI and pulse pressure in older adults with isolated systolic hypertension found that pulse pressure decreased with an increasing BMI, but this decrease slowed when BMI was >25 and reversed when BMI was 30.1. Overall, pulse pressure was found to be higher in the women than in the men among the lean and the overweight participants, but there were remarkable differences in the relationship between BMI and pulse pressure among men and women. Based on the relationship between BMI and the cardiovascular parameters, a number of clinical measurements for obesity have been used to determine susceptibility to cardiovascular diseases [28]. These measurements include body mass index (BMI), waist-hip ratio (WHR) and waist circumference (WC) [30].

Conclusion

The study demonstrated that body mass index, age and gender are closely associated with cardiovascular parameters, such as systolic, diastolic, pulse and mean arterial pressures. Though the degree of correlation differed, there was a positive and significant correlation among age and the cardiovascular parameters while the relationships between gender and BMI with cardiovascular parameters were found to be statistically insignificant. The risk of hypertension is therefore expected to be higher among the aged and populations who are overweight or obese.

Finally, this work has revealed that contrary to popular belief that hypertension is more common among men, in Bayelsa state, the prevalence of hypertension is found to be more common among women than in men. This further reveals that the gender with the highest prevalence of hypertension is dependent on the geographical location and the role or occupation assigned to a particular gender in the given location.

Acknowledgments

The authors would like to express warm appreciation to Professors D. V. Dapper and I. M. Siminialayi of the Departments of Human Physiology and Pharmacology respectively, College of Health Sciences, University of Port Harcourt, Nigeria for their immense technical assistance.

Source of funding

The research was solely and completely funded by the authors only.

References

  1. Lawes CM, Vander Hoorn S, Rodgers A; International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008 May 3;371(9623):1513-8. [Crossref] [Pubmed]
  2. Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P, Mbanya JC, McKee M, Moodie R, Nishtar S, Piot P, Reddy KS, Stuckler D; Lancet NCD Action Group. UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet. 2011 Jul 30;378(9789):449-55. [Crossref] [Pubmed]
  3. World Health Organisation. Global status report on non-communicable diseases 2014. Geneva: World Health Organisation; 2014 Oct 26. Available from: https://www.who.int/publications/i/item/9789241564854 Reference Number: WHO/NMH/NVI/15.1. 280p.
  4. Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: a systematic review and meta-analysis. J Hypertens. 2015 Feb;33(2):230-42. [Crossref] [Pubmed]
  5. Campbell NR, Lackland DT, Lisheng L, Niebylski ML, Nilsson PM, Zhang XH. Using the Global Burden of Disease study to assist development of nation-specific fact sheets to promote prevention and control of hypertension and reduction in dietary salt: a resource from the World Hypertension League. J Clin Hypertens (Greenwich). 2015 Mar;17(3):165-7. [Crossref] [Pubmed]
  6. Poulter NR, Prabhakaran D, Caulfield M. Hypertension. Lancet. 2015 Aug 22;386(9995):801-12. [Crossref] [Pubmed]
  7. Carretero OA, Oparil S. Essential hypertension. Part I: definition and etiology. Circulation. 2000 Jan 25;101(3):329-35. [Crossref] [Pubmed]
  8. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71(6):e13-e115. [Crossref] [Pubmed]
  9. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Rydén L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013 Jul;34(28):2159-219. [Crossref] [Pubmed]
  10. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. [Crossref] [Pubmed]
  11. Uppangala C, Kodavanji B, Na V, Noojibail A, Kini RD, Arunkumar N, Avabratha S, Pai SR, Kumar CP. Comparison of heart rate variability in different ABO blood groups of young adults. Int J Med Sci Public Health. 2014; 3(12):1466-9. [Crossref]
  12. Musini VM, Tejani AM, Bassett K, Puil L, Wright JM. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database Syst Rev. 2019 Jun 5;6(6):CD000028. [Crossref] [Pubmed] [Pubmed Central]
  13. Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci. 2006; 1:9-14.
  14. Landi F, Calvani R, Picca A, Tosato M, Martone AM, Ortolani E, Sisto A, D'Angelo E, Serafini E, Desideri G, Fuga MT, Marzetti E. Body Mass Index is Strongly Associated with Hypertension: Results from the Longevity Check-up 7+ Study. Nutrients. 2018 Dec 13;10(12):1976. [Crossref] [Pubmed] [Pubmed Central]
  15. Teli SS, Divya R, Paramasivam L, Velou MS. Association of ABO and Rh blood groups with blood pressure : A cross sectional study in South Indian population. Indian J Basic Applied Med Res. 2016 Jun; 5(3):8-13.
  16. Murthy GV, Fox S, Sivasubramaniam S, Gilbert CE, Mahdi AM, Imam AU, Entekume G; Nigeria National Blindness and Visual Impairment study group. Prevalence and risk factors for hypertension and association with ethnicity in Nigeria: results from a national survey. Cardiovasc J Afr. 2013 Oct-Nov;24(9-10):344-50. [Crossref] [Pubmed] [Pubmed Central]
  17. Ujunwa FA, Ikefuna AN, Nwokocha AR, Chinawa JM. Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria. Ital J Pediatr. 2013 Nov 2;39:70. [Crossref] [Pubmed] [Pubmed Central]
  18. Akinlua JT, Meakin R, Umar AM, Freemantle N. Current Prevalence Pattern of Hypertension in Nigeria: A Systematic Review. PLoS One. 2015 Oct 13;10(10):e0140021. [Crossref] [Pubmed] [Pubmed Central]
  19. Tabatabaie AH, Ali-Madadi M. Possible association between ABO and Rh (D) blood groups and hypertension. Pak J Med Sci. 2012;28(1):235-7.
  20. Srivastava R, Upadhyay A. Relation of ABO blood group with blood pressure in 25-35 years of age group in normal population of Agra. Indian J Clin Anat Physiol. 2019; 6(1):5-9. [Crossref]
  21. Visscher TL, Seidell JC. The public health impact of obesity. Annu Rev Public Health. 2001;22:355-75. [Crossref] [Pubmed]
  22. Cameron AJ, Welborn TA, Zimmet PZ, Dunstan DW, Owen N, Salmon J, Dalton M, Jolley D, Shaw JE. Overweight and obesity in Australia: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust. 2003 May 5;178(9):427-32. [Crossref] [Pubmed]
  23. Després JP, Lemieux I, Prud'homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ. 2001 Mar 24;322(7288):716-20. [Crossref] [Pubmed] [Pubmed Central]
  24. Gluckman TJ, Baranowski B, Ashen MD, Henrikson CA, McAllister M, Braunstein JB, Blumenthal RS. A practical and evidence-based approach to cardiovascular disease risk reduction. Arch Intern Med. 2004 Jul 26;164(14):1490-500. [Crossref] [Pubmed]
  25. Wilson PW, D'Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002 Sep 9;162(16):1867-72. [Crossref] [Pubmed]
  26. Sakhare SS, Kamble NA, Sakhare SC. Study of correlation between body mass index, age and various cardiovascular parameters. World Journal of Pharmacy and Pharmaceutical Sciences. 2019; 7(6):897-906. [Crossref]
  27. Kapoor SS. Blood pressure, waist to hip ratio and body mass index among affluent Punjabi girls of Delhi. Acta Medica Auxologica. 2000; 32(3):153-7.
  28. Gupta R, Guptha S, Gupta VP, Prakash H. Prevalence and determinants of hypertension in the urban population of Jaipur in western India. J Hypertens. 1995 Oct;13(10):1193-200. [Crossref] [Pubmed]
  29. Frost CD, Law MR, Wald NJ. By how much does dietary salt reduction lower blood pressure? II--Analysis of observational data within populations. BMJ. 1991 Apr 6;302(6780):815-8. [Crossref] [Pubmed] [Pubmed Central]
  30. Bray GA, Jablonski KA, Fujimoto WY, Barrett-Connor E, Haffner S, Hanson RL, Hill JO, Hubbard V, Kriska A, Stamm E, Pi-Sunyer FX; Diabetes Prevention Program Research Group. Relation of central adiposity and body mass index to the development of diabetes in the Diabetes Prevention Program. Am J Clin Nutr. 2008 May;87(5):1212-8. [Crossref] [Pubmed] [Pubmed Central]