The "Pressure" of Being an Adolescent in West Bank, Palestine: Prevalence of Prehypertension and Hypertension

Dina Hamideh^1*Hamzeh Al Zabadi²Noe C Crespo³John Alcaraz³Mariam Mansour¹Marcos Real¹Baseel Hamideh¹Nargis Ahmadi¹Lamees Mahmoud²David Strong¹

• ¹University of California, San Diego, La Jolla, United States
• ²An Najah National University, Nablus, Palestine
• ³San Diego State University, San Diego, United States

Over 27% of adults in Palestine are reported to have hypertension, and there is limited knowledge of hypertension rates among Palestinian adolescents residing in West Bank, Palestine. Prolonged exposure to forced displacement has adverse impacts on health, including hypertension. This study assessed the relationship between refugee status, prehypertension and hypertension among Palestinian adolescents residing in West Bank, Palestine.This cross-sectional study was conducted among Palestinian adolescents residing in refugee camps, villages, and cities across the West Bank. A random sample of adolescents were recruited through schools from November 2022 to January 2023. Anthropometric measurements including blood pressure (mmHg), heart rate (BPM), body fat (%), height (cm), body weight (kg) and survey questionnaires were collected. Ordinal regression models were used to assess the relationship between refugee status, prehypertension, and hypertension while controlling for age. Additionally, the interaction between refugee status and sex and its relationship on the prevalence of prehypertension and hypertension was examined.A total of 706 Palestinian adolescents (refugees= 377, [39.4 % females, 60.6 % males] and non-refugees= 329 [39.9% females, 60.1% males]) aged 13-17 (median= 14 years) were enrolled. The prevalence of prehypertension and hypertension in the sample was 26% and 14% respectively. The prevalence of prehypertension [refugees=25.5% vs. non-refugees= 27.0%] and hypertension [refugees=12.7% vs. non-refugees= 16.0%] was higher in non-refugees. There was no association between refugee status and hypertension categories in unadjusted models, or models adjusting for age [adjusted odds ratio (AOR) 0.88; 95% CI= 0.65-1.20]. The interaction in the regression models demonstrated an association between refugee status, prehypertension and hypertension for females and males. Among females, refugees had 1.75 [95%CI=1.04-2.95] times higher odds of higher blood pressure than non-refugees after adjusting for age. In contrast, male refugees had 40% lower odds [AOR = 0.6; 95% CI = 0.41-0.88] of having higher blood pressure than male non-refugee counterparts. Prehypertension and hypertension prevalence was high for this participant sample, highlighting a significant public health concern. Inverse relationships between blood pressure and refugee status were observed by sex. Future studies should assess the impact of refugee and non-refugee experiences and sex differences on cardiovascular health disparities among Palestinian adolescents.