European Journal of Cardiovascular Medicine

Hypertension, or elevated blood pressure, is a leading global health challenge and a major risk factor for cardiovascular diseases, stroke, and renal failure [1]. Traditionally perceived as a condition affecting older populations, recent evidence suggests a disturbing trend of increasing prevalence among young adults, particularly in rapidly urbanizing settings [2]. Urban lifestyles, characterized by high stress, sedentary habits, unhealthy diets, and exposure to environmental pollutants, have been associated with early onset of hypertension [3].

The World Health Organization estimates that over 1.28 billion adults worldwide have hypertension, with a significant proportion being undiagnosed or inadequately treated, especially among younger age groups [4]. In urban areas of developing countries, the epidemiological shift towards non-communicable diseases such as hypertension is becoming more pronounced, driven by lifestyle and socioeconomic transitions [5]. Young adults, often perceived as being at low risk, are not routinely screened, leading to delayed diagnosis and increased long-term health complications [6].

Moreover, the early development of hypertension in youth is linked to longer lifetime exposure to elevated blood pressure and a higher likelihood of end-organ damage [7]. Several studies have identified modifiable risk factors such as obesity, physical inactivity, poor dietary habits, smoking, and alcohol consumption as significant contributors in young urban populations [8,9]. However, data specific to urban young adults, particularly in South Asian and other low-middle income countries, remain sparse and fragmented [10].

This study aims to estimate the prevalence of hypertension among young adults residing in urban settings and to evaluate associated sociodemographic and behavioural risk factors. The findings are expected to inform targeted prevention strategies and early intervention approaches.

Study Design and Setting: This was a community-based cross-sectional study conducted over a period of six months in three urban metropolitan regions. The selected areas were characterized by high population density, diverse socioeconomic backgrounds, and rapid urban development.

Study Population: Young adults aged between 18 and 35 years, residing in the selected urban regions for at least six months, were considered eligible for inclusion. Individuals with known secondary hypertension or those on antihypertensive therapy were excluded from the study.

Sample Size and Sampling Technique: A sample size of 800 participants was calculated based on a hypothesized hypertension prevalence of 25%, a 95% confidence level, and a 5% margin of error. A multistage random sampling method was employed. Initially, urban wards were randomly selected, followed by systematic selection of households. One eligible participant was selected randomly from each household using the Kish grid method.

Data Collection Tools and Procedure: A structured and pre-tested questionnaire was used to collect data on demographic information, family history of hypertension, dietary habits, physical activity, smoking, alcohol consumption, and stress levels. Anthropometric measurements such as height and weight were taken using standard protocols to calculate body mass index (BMI).

Blood Pressure Measurement: Blood pressure was measured using a standard mercury sphygmomanometer with an appropriately sized cuff. Readings were taken from the right arm after the participant had rested for at least five minutes in a sitting position. Two readings were recorded at an interval of five minutes, and the average value was considered for analysis. Hypertension was defined as systolic blood pressure (SBP) ≥130 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg, in line with the American Heart Association (AHA) 2017 guidelines.

Statistical Analysis: The collected data were entered and analyzed using SPSS version 25. Descriptive statistics such as frequencies, percentages, means, and standard deviations were calculated. The Chi-square test was used to identify associations between hypertension and categorical variables. Multivariate logistic regression analysis was performed to determine independent risk factors for hypertension, with significance set at p<0.05.

A total of 800 young adults participated in the study, with a mean age of 27.4 ± 4.9 years. Of these, 420 (52.5%) were male and 380 (47.5%) were female. The overall prevalence of hypertension was found to be 24.8% (n=198), with a significantly higher proportion observed among males (28.3%) compared to females (20.4%) (p = 0.016) [Table 1].

Table 1: Prevalence of Hypertension According to Gender

Lifestyle and behavioural characteristics of the participants are presented in Table 2. Among the hypertensive individuals, 67.2% had a family history of hypertension, 58.1% were overweight or obese (BMI ≥25 kg/m²), and 45.9% reported low physical activity levels. High salt intake was reported by 53.5% of hypertensive participants. A statistically significant association was found between hypertension and all of these variables (p < 0.05).

Table 2: Distribution of Risk Factors among Hypertensive and Normotensive Participants

Multivariate logistic regression analysis (Table 3) revealed that family history of hypertension (OR: 2.75, 95% CI: 1.95–3.88), BMI ≥25 kg/m² (OR: 2.34, 95% CI: 1.65–3.33), high dietary salt intake (OR: 1.92, 95% CI: 1.33–2.76), and physical inactivity (OR: 1.68, 95% CI: 1.18–2.41) were significant independent predictors of hypertension.

Table 3: Multivariate Logistic Regression Analysis of Risk Factors for Hypertension

These findings indicate a strong association between modifiable lifestyle factors and elevated blood pressure in the young urban population (Tables 1–3).

The present study reveals a significant prevalence of hypertension (24.8%) among young adults in urban areas, highlighting an emerging public health issue that warrants immediate attention. The observed prevalence is consistent with findings from similar urban-centric studies across South Asia and Africa, which report hypertension rates ranging from 20% to 30% in comparable age groups [1,2]. Notably, male participants demonstrated a higher prevalence than females, aligning with earlier reports suggesting that men are more prone to early-onset hypertension due to higher exposure to modifiable risk factors such as smoking and alcohol use [3].

Family history of hypertension emerged as the most significant predictor in this study. Participants with a positive family history had nearly 2.75 times higher odds of developing hypertension compared to those without, reinforcing the genetic predisposition and familial clustering of blood pressure regulation abnormalities [4,5]. This underscores the need for early screening and health education in genetically predisposed individuals.

Obesity and overweight status (BMI ≥25 kg/m²) were also strongly associated with elevated blood pressure, echoing findings from previous research that links increased adiposity with higher peripheral resistance and vascular inflammation [6,7]. Urban lifestyles contribute significantly to this trend due to the prevalence of sedentary behaviour, processed food consumption, and limited physical activity [8].

Physical inactivity, another prominent factor identified in this study, independently increased the risk of hypertension by 1.68 times. Similar results have been reported in multi-national studies, which indicate that regular physical activity can reduce systolic and diastolic blood pressure through improved endothelial function and arterial elasticity [9,10]. This highlights the importance of promoting active lifestyles through community-level interventions.

Dietary salt intake was significantly associated with increased hypertension prevalence, supporting global evidence on the adverse effects of excessive sodium consumption [11]. Urban populations tend to consume more processed and fast foods, which are major sources of hidden salt [12]. The World Health Organization has emphasized salt reduction as a cost-effective measure to control hypertension worldwide [13].

Substance use, particularly tobacco and alcohol, was also significantly associated with higher blood pressure levels in this cohort. Nicotine induces sympathetic stimulation and vasoconstriction, while alcohol contributes to vascular damage and altered renal function, both of which promote hypertension [14,15]. These findings emphasize the need for behaviour change communication strategies and robust policy-level interventions targeting youth.

Overall, the results demonstrate that a combination of genetic, behavioural, and lifestyle factors contributes to the rising burden of hypertension among young urban adults. This growing prevalence has serious long-term implications, as early-onset hypertension is associated with a greater cumulative risk for cardiovascular events, chronic kidney disease, and premature mortality [6,7]. Importantly, many of the identified risk factors are modifiable, presenting opportunities for effective prevention and control.

Despite the relevance of these findings, the study has some limitations. The cross-sectional design restricts causal inference. Blood pressure measurements were recorded during a single visit, which may not capture white-coat hypertension or masked hypertension. Additionally, self-reported data on lifestyle habits may be subject to recall bias.

Future longitudinal studies are recommended to track blood pressure changes over time and assess the effectiveness of targeted interventions. Implementing early lifestyle modifications and improving awareness through educational campaigns can play a key role in reducing the incidence of hypertension in this vulnerable age group.

This study highlights a concerning prevalence of hypertension among young adults in urban settings, driven largely by modifiable lifestyle factors such as poor diet, physical inactivity, obesity, and family history. Early detection, health education, and preventive interventions targeting youth are crucial to curb the growing burden of hypertension and its long-term complications.

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