Hypertension Rates High Among Medical Students

NEW ORLEANS — Among medical students, rates of hypertension are more than twice those of members of the general public who are of the same age, a new study suggests.

The findings come from a survey and examination of first- and second-year students at DeBusk College of Osteopathic Medicine of Lincoln Memorial University, in Harrogate, Tennessee, and were reported here at the American Heart Association's Hypertension 2019 Scientific Sessions.

Researchers found that almost 18% of medical students had stage 2 hypertension, compared to fewer than 8% of members of the general population who were the same age. The prevalence is approximately 2.4 times higher than expected.

"We were a bit surprised that rates of stage 2 hypertension were that much higher than the general populous," said Jacek Bednarz Jr, a third-year medical student at DeBusk who coauthored the study along with Daniel W. Mok, also a third-year student.

"Being future doctors, we know that hypertension's a silent killer. We study this, but do we really look at our own health?" added Mok.

Per the National Center for Health Statistics, 7.5% of US adults aged 18 to 39 years have stage 2 hypertension, as defined in 2017 ACC/AHA guidelines (blood pressure ≥140/90 mmHg). The authors of the current study believe theirs is one of the first to survey blood pressure and its associated risk factors among US medical students. Some studies from other countries have also found risk to be elevated among students.

In an interview with Medscape Medical News, Bednarz and Mok said they can understand the elevated risk, inasmuch as medical students are sedentary for most of the day, they are under pressure to perform, and they lack time to exercise and to cook healthy meals.

For the study, 213 first- and second-year students from the DeBusk College of Osteopathic Medicine completed a survey that asked questions regarding age, participants' sex, tobacco use, alcohol consumption, diet, aerobic exercise, mental health, social support, and past medical history.

Sphygmomanometers (Omron Healthcare model BP710N) were used to measure blood pressures in the left arm. Participants avoided exercise and smoking for at least 30 minutes before measurements. Blood pressure level was determined as the average of two or three measurements.

A third measurement was taken if the difference of systemic or diastolic pressure between the first and second readings exceeded 10 mmHg. Waist circumference was measured around the umbilicus. Hypertension stages were defined in accordance with 2017 ACC/AHA guidelines.

Students were equally divided between male and female; the mean age was 26 years (range, 21 – 37).

Elevated Blood Pressure in Almost Two Thirds

Using 2017 ACC/AHA guideline thresholds, only 36.6% of the medical students were normotensive. The researchers observed elevated blood pressure in 16.4% of the participants, stage 1 hypertension in 29.1%, and stage 2 hypertension in 17.8%, Bednarz and Mok reported (see Table).

The 17.8% rate of hypertension was about 2.4 times higher than the 7.5% rate observed for US adults aged 18 to 39 years, as indicated by data from National Center for Health Statistics for the period 2015 – 2016, they noted.

Table. Blood Pressure Levels in Male and Female Medical Students

BP Category (%)	Men, % (n = 106)	Women, % (n = 105)	Total, % (n = 211)
Normotensive	19.81	53.33	36.6
Elevated	23.58	9.52	16.4
Stage 1 hypertension	32.08	25.71	29.1
Stage 2 hypertension	24.53	11.43	17.8

According to the guidelines, normal pressure is defined by systolic blood pressure (SBP) <120 mmHg and diastolic (DBP) <80 mmHg. Elevated blood pressure is defined as SBP of 120 – 129 mmHg and DBP <80 mmHg. Stage 1 hypertension is defined as SBP of 130 – 139 mmHg or DBP of 80 – 89 mmHg. Stage 2 hypertension is defined as SBP ≥140 mmHg or DBP ≥90 mmHg.

Risk Factors for Hypertension

The regression analysis identified significant risk factors associated with the presence of hypertension. Most strikingly, male students were 13.3 times more likely to develop hypertension than female students (P < .001). An increase in waist circumference by 1 inch was associated with an 11% increase in stage 2 hypertension (P < .001), and sleeping less than 6 hours a night was associated with a 37% increase in hypertension (P = .028).

Interestingly, exercise, anxiety, and diet were not significant factors.

The authors said that they have not shared the findings with their peers at DeBusk but plan to do so.

"We just want to raise awareness for all of us," said Mok. "We're saying you need to check your blood pressure, because there are ways (like lifestyle changes) to prevent further complications."

"I think the message is that even though we are going into the medical profession to care for other people outside of our profession, we still have to look at our own health," added Bednarz. "We don't think about the things that are just slowly eating away at us."

Bednarz, Mok, and Lawrence have disclosed no relevant financial relationships.

Hypertension 2019 Scientific Sessions: Abstract P2059, presented September 6, 2019.

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