Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : AC01 - AC05 Full Version

Determining New Anthropometric Markers for Screening Hypertension in the Caribbean Region

Published: August 1, 2021 | DOI:
Amruta Rajput , Upendra Gupta , Rekha Parashar , Guri Tzivion , Ravindrasingh Rajput

1. Instructor, Department of Anatomy, American University of Antigua College of Medicine, Coolidge, St. John, Antigua and Barbuda. 2. Professor and Head, Department of Anatomy, National Institute of Medical Sciences, Jaipur, Rajasthan, India. 3. Assistant Professor, Department of Anatomy, National Institute of Medical Sciences, Jaipur, Rajasthan, India. 4. Professor and Head, Department of Molecular Sciences, Windsor School of Medicine, Brightons estate, Cayon, Saint Kitts and Nevis. 5. Associate Professor, Department of Pathophysiology, American University of Antigua College of Medicine, Coolidge, St. John, Antigua and Barbuda.

Correspondence Address :
Amruta Rajput,
University Park, Jabberwock Beach Road, PO Box W1451,
Coolidge, St. John, Antigua and Barbuda.


Introduction: The prevalence of hypertension in the Caribbean is high [26% in Saint (St.) Kitts]. It contributes to 51% of deaths secondary to ischemic heart disease and hence being a leading cause of death in the Caribbean region.

Aim: To determine the association between Indices using height, waist, hip, thigh, arm, and wrist circumference (cm) with development of hypertension and to compare existing markers in test subjects and assessing their feasibility as predictive indicators for the development of hypertension.

Materials and Methods: In the present cross-sectional study, a total of 635 subjects were involved in the study which included health centres and health camps in St. Kitts (West Indies). Study was conducted from December 2019 to November 2020. Height to Waist Ratio (HtWR), Arav Body Index (ABI), Waist to Thigh Ratio (WTR) and Wrist to Arm Ratio (WAR) was compared to common existing markers such as Waist to Height Ratio (WHtR), Waist to Hip Ratio (WHR) and Body Mass Index (BMI). Statistical analysis was done using using IBM Statistical Package for the Social Sciences (SPSS) version 23.0.

Results: A total of 635 participants were included with most of the participants (n=540) between age group of 40 to 70 years, 35.4% (n=225) of participants were males and 64.6% (n=410) were females. In the present study, 47.92% (n=304) were non hypertensive and 52.1% (n=331) were hypertensive. In males, Area Under Receiver Operating Curve (AUROC) of HtWR (0.690) and Inverse ABI (0.632) was superior as compared to other anthropometric markers for predicting the development of hypertension and Waist to Thigh Ratio (WTR) (0.687) was superior in females. Among females recommended cut-off values for WTR is 1.6 and among males for HtWR and Inverse ABI were 2.3 and 2.84, respectively.

Conclusion: Height to waist ratio and inverse ABI were more reliable markers in males for predicting the development of hypertension whereas, WTR being more reliable in females in population of St. Kitts. This will help at risk individuals to take preventive measures like lifestyle modification.


Anthropometric measures, Arav body index, Height to waist ratio, Receiver operating characteristics

The number of patients with hypertension is likely to grow as the population ages and grow old, since either isolated systolic hypertension or combined systolic and diastolic hypertension occurs in the majority of persons older than 65 years. Hypertension is a major risk factor for cardiovascular diseases in Caribbean region and globally too. It contributes to 51% of deaths secondary to ischemic heart disease and hence being a leading cause of death in the Caribbean region (1). The rate of occurrence of obesity will also increase the number of hypertensive individuals and can also be associated with early onset of hypertension.

Several reports indicates that there is higher prevalence of hypertension in the Caribbean region. Hypertension affects around 21% of adults from Barbados and Trinidad and Tobago region. 25% of adults are affected in Jamaica (2) and as high as 26% are affected in St. Kitts and Nevis region (3). Such higher prevalence of hypertension can place a high burden of its known complications and overall health care costs. Reports from many Caribbean regions show prevalence of hypertension among males is higher than females (4).

Risk factors associated with hypertension can be classified as modifiable and non modifiable risk factors. Non modifiable risk factors are those characteristics in the patient which cannot be changed. Hence, not much can be done to address such risk factors. Modifiable risk factors are those which can be intervened and changed such as obesity, high fat intake, high dietary salt consumption, sedentary lifestyle and excessive tobacco or alcohol consumption (5). Certain dietary habits especially high salt intake is associated with hypertension and cardiovascular diseases. Almost 30% of cases of hypertension is associated with high dietary sodium intake (6),(7). Once the modifiable risk factors are identified then necessary lifestyle modifications can be implemented to control hypertension. The present study assesses the anthropometric indices as a tool to determine the risk of development of hypertension in an individual so that early interventions can be implemented to prevent development of hypertension. Obesity related hypertension and level of leptin and insulin in the body needs further attention and research. Studies have shown activation of Sympathetic Nervous System (SNS) in obese individuals particularly in abdominal fat accumulation particularly in males (8),(9). These findings have great implications for knowing at risk patients with visceral obesity (8).

In Jamaica, a Caribbean island, about 28% of hypertensive patients had well controlled blood pressure which were assessed over a period from 1995 to 2013. One of the important reasons contributed to improvement was ease of availability of effective antihypertensive medications like Angiotensin Converting Enzyme (ACE) inhibitors, Angiotensin Receptor Blockers (ARBs) and Calcium Channel Blockers (CCBs) compared to conventional drugs (10). The uncontrolled hypertension can lead to emergency hypertension which is associated with evidence of end organ damage including stroke, myocardial infarction, cardiac failure, dementia, renal failure, and blindness (11),(12).

BMI has been long standing traditional anthropometric markers used worldwide and it defines degree of obesity. There has been increase in trend in exploration of newer markers like waist and hip circumferences, WHR, WHtR among others which can show better relationship with obesity and correlation with development of cardiovascular disorders and Type 2 Diabetes Mellitus (T2DM) (13).

The Waist Circumference (WC) has gathered quiet an attention over the years as a reliable indicator of abdominal adiposity and its relationship with cardiovascular disorder. One of the reasons for emerging anthropometric markers is BMI fails to discern between the muscle mass and body fat, especially abdominal fat in males, hence is not a reliable indicator for obesity and is not a strong discriminator of cardiovascular disease risk factor (14),(15). The markers involving WC like WHR and WHtR are used as markers to establish degree of body fat centralisation (16),(17),(18). Various studies have shown strong correlation of central distribution of body fat with hypertension (16),(19),(20). Due to higher prevalence of hypertension in the Caribbean and questionable reliability of the conventional anthropometric markers, there is a need to explore newer and more reliable anthropometric markers, as well as to ascertain the validity of existing markers in screening subjects at risk of development of hypertension.

The primary objective of the study was to evaluate ability of ABI, WTR and WAR in determining association with hypertension. The other objectives were to compare the above anthropometric indices with existing one like BMI, WHtR and WHR and as well as to determine cut-off values in the Caribbean population.

Material and Methods

The present cross-sectional population-based study involved subjects utilising all health centres and health fairs in St. Kitts and Nevis region. Ethnicity and sex was self-reported. A written consent was taken from the participant for participation in research study. The study duration was of one year (December 2019 to November 2020). Participants were divided into two groups, as non hypertensive group and hypertensive group. The study was reviewed and approved by Interim Ethics Review Committee (IERC-2019-11-031) under Ministry of health, St. Kitts and Nevis.

Sample size calculation: The sample size was calculated based on prevalence of the hypertension in 26% of the population of St. Kitts and Nevis (3) using n=z2pq/e2 wherein, n=sample size, p=estimated prevalence of hypertension, q=1-p, z=1.96 for a confidence level (α) of 95% and e2 is margin of error (21). N=1.962×0.26×0.74/(0.05)2=296. The minimum sample size required was 296 subjects in each group.

Inclusion criteria: Subjects with age between 20 to 70 years and with self-reported history of hypertension and subjects without history of hypertension were included in the study.

Exclusion criteria: Subjects who were pregnant and lactating at the time of study, recorded weight was incomplete or implausible (eg., BMI <15 or >45 kg/m2; weight <30 or >150 kg; height <130 or >190 cm; and the difference between systolic and diastolic blood pressure <10 mmHg) were excluded from the study. The subjects who involved in body building and athletic events/sports since past one month were also excluded. Subjects with T2DM were excluded from this study.

Hypertension was defined based on self reported physician-diagnosed hypertension or self reported current intake of anti-hypertensive medication during the seven days prior to the participation in the study. Covariates, such as age, sex, smoking habits and alcohol consumption were collected by direct interviews.

Anthropometric Measurement

Height was measured using a Stadiometer. Weight was measured using a calibrated digital weighing scale. Waist, hip, thigh, arm and wrist circumference was measured using calibrated tape. BMI is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). Cut-off standards by the World Health Organisation (WHO) was used (22).

The WC was measured to the nearest centimeter using a flexible tape with the respondent standing. In females, the abdominal circumference (waist) was measured as the narrowest part of the body between chest and hips and in males it was measured at the level of the umbilicus. Measurements were taken at the end of normal expiration. The participant’s hip circumference was measured at the maximum circumference around buttocks posteriorly at the level of greater trochanters and measured in cm. Thigh circumference (cm) was measured in participants at mid thigh on the right side. Mid-thigh circumference in this study was the midpoint between the superior ridge of the patella inferiorly and the crease of the groin superiorly. The arm circumference is the circumference of the upper arm which was estimated using measuring point midway between the olecranon process of the ulna inferiorly and the acromion process of the scapula superiorly, measured with a non stretchable calibrated tape measure on the right side of the patient. All circumferences were measured in centimeters.

The WHR was determined by dividing WC by hip circumference (cm). WHtR is defined as WC divided by height in centimeters. This ratio is a measure of the distribution of body fat. Higher values of WHtR indicate higher risk of obesity-related cardiovascular diseases; it is correlated with abdominal obesity. HtWR which is inverse of WHtR was also taken into consideration. TWR was determined by dividing WC by thigh circumference (cm). WAR was determined by dividing wrist circumference by arm circumference. ABI is newer index was measured using following equation: ABI=WC/(Thigh circumference+Height) (all units in cm) (23). Blood pressure was taken in a seated position and on the right arm by trained health workers who did follow a standardised procedure using regularly calibrated mercury sphygmomanometers or Omron digital devices, Indonesia Family Life Survey (IFLS).

Statistical Analysis

The distributions of continuous anthropometric and clinical variables will be described using measures of central tendency and variation (means and standard deviations). Mean was compared using independent t-test. Receiver-Operating Characteristic (ROC) curve analysis was used to examine the overall discriminatory power represented by Receiver-Operating Characteristic Curve Analysis (AROC), sensitivity and specificity, and corresponding cut-off points of each of the anthropometric indices for hypertension using IBM SPSS version 23.0.


In the present study, out of 635 participants 47.9% were non hypertensive (n=304) and 52.1% (n=331) hypertensive, 15% (n=95) were between age group 20 to 39 years and 85% (n=540) were between age group 40 to 70 years. A 35.4% (n=225) of participants were males and 64.6% (n=410) were females. The study participant’s mean weight (Kg), height (cm), WC (cm), hip circumference (cm), thigh circumference (cm), arm circumference (cm) and wrist circumference (cm) were 80.16±18.41, 167.70±11.47, 90.50±13.63, 103.80±15.04, 52.87±11.36, 30.71±6.55 and 16.03±2.44, respectively.

The ABI had lower AROC and was not significant marker in the development of hypertension whereas 1/ABI (Inverse ABI) showed higher AROC and significant association hence, inverse ABI was used in the present study. The means of anthropometric measurements and indices (hypertensive and non hypertensive groups) were subjected to independent sample t-test. There was no significant difference between the mean height between hypertensive (167.84±11.43 cm) and non hypertensive (167.70±11.47 cm) groups. There was no significant difference in weight, thigh, hip, arm circumference, WAR and WTR in either group. Waist, wrist circumference, inverse ABI, BMI, WHR and WHtR was significantly lower in hypertensive group (88.55±14.18, 15.77±2.55, 28.39±6.90, 0.86±.08, 0.52±0.08, respectively) compared to non hypertensive group (92.63±12.70, 16.32±2.29, 29.0±5.97, 0.88±.07, 0.55±0.08, respectively). Mean HtWR and inverse ABI were significantly higher in hypertensive group (1.94±.36, 2.41±.30) compared to non- hypertensive group (1.84±.27, 2.55±.46, respectively) (Table/Fig 1).

Inverse ABI, HtWR in males and WTR in females showed superior values of AROC compared to WHtR, WAR and BMI. AROC of BMI and WtHR were low and not significant in both males and females as compared to studies in done in geographical locations of Iraq, Korea, China and Jordan (24),(25),(26),(27). HtWR and Inverse ABI were more reliable markers in males for predicting the development of hypertension whereas, WTR being more reliable in females. The present study has not shown commonly used anthropometric markers such as BMI, WHR and WHtR as reliable in predicting development of hypertension in population of Saint Kitts (Table/Fig 2), (Table/Fig 3), (Table/Fig 4) (24),(25),(26),(27).

The cut-off values for WC, HC, BMI, WHtR, HtWR, WHR, inverse ABI, WTR and WAR was 100.8, 121.4, 24.27, 0.57, 2.30, 0.96, 2.84, 2.0, 0.66 respectively in males. The cut-off values for WC, HC, BMI, WHtR, HtWR, WHR, Inverse ABI, WTR and WAR was 84.4, 122.2, 33.9, 0.54, 1.64, 0.87, 2.13, 1.6, 0.41, respectively in females. Cut-off values of these anthropometric measurements and indices were comparable to that of various studies (Table/Fig 5) (24),(25),(26),(27),(28),(29).


BMI has been weakest predictor of the hypertension as compared to other markers and the data is comparable to studies by Wang Q et al., and Lee JW et al., has contrasting evidence (25),(27) with that of Mansour AA and Al-Jazairi MI and Khader Y et al., (24),(26). Authors determine that BMI is not reliable marker in determining development of hypertension, but it was more reliable in predicting T2DM (23).

A study in Tehran showed WC as an important marker in predicting development of hypertension but this study did not show the significant association (30). In the present study, WHR and WHtR did not show strong association in determining development of hypertension as shown by other studies compared in (Table/Fig 4). Interestingly, inverse of WHtR i.e., HtWR and Inverse ABI (in males) showed significant association in development of hypertension.

Shi J et al., noted in their study in China that thigh circumference was negatively correlated with systolic and diastolic blood pressure. Individuals with larger thigh circumference group had lower risk of hypertension in both overweight individuals and obese individuals (31). Larger thigh circumference tends to reduce WTR and risk of hypertension. In this study, WTR is significantly associated with the development of hypertension in females but not in males.

HtWR (0.690) and inverse ABI (0.662) had the highest AUROC value in males and WTR (0.687) in females among other compared adiposity indices such as WHtR, WHR, WAR and BMI. The results were contrasting in the present study compared to those done in geographical locations of Iraq, Korea, China and Jordan (24),(25),(26),(27). This may be due to the present study population was predominantly of African descent and significant variation in some of the anthropometric markers is expected, for example in hip circumference and BMI. More studies in the other Caribbean regions are needed to support these results.

The cut-off values with sensitivity and specificity for HtWR, inverse ABI and WTR were 2.3 (0.424, 0.966), 2.84 (0.424, 0.915) and 2.0 (0.261, 0.805) in males and 1.64 (0.782, 0.444), 2.13 (0.904, 0.287) and 1.6 (0.824, 0.433) in females, respectively. Among females, with WTR>1.6, 67% (n=197) had hypertension, 33% (n=97) did not have hypertension. Among males with HtWR of > 2.3, 91% (n=39) had hypertension and 9% (n=4) did not. For inverse ABI of >2.84, 81% of males (n=34) had hypertension and 19% (n=9) did not.


The limitations of the present study were inclusion of younger population, as the chronic diseases such as hypertension and T2DM usually onset at an age of 40 years and above (32). Since this was a health-centre based study, the likelihood of hypertension was more among the participants which possibly contributed to the high prevalence rate. The results were just representative of a smaller proportion of the Caribbean population, so more studies are needed in different geographical location within the Caribbean region to get a better picture.


The present study results have shown WTR, HtWR and Inverse ABI in both males and females as superior anthropometric marker compared to WHtR, WAR, WHR and BMI. HtWR of less than 2.3 (males), Inverse ABI of less than 2.8 (males), and WTR of less than 1.6 (females) reduces the likelihood of development of hypertension. Exercise and lifestyle modifications can address the modifiable risk factors can delay or prevent development or progression of hypertension. We conclude that HtWR, Inverse ABI and WTR could be a more reliable tool for identifying individuals at risk of development of hypertension and will help them to take preventive measures like lifestyle modification. Authors recommend having a long-term follow-up study with enrolled participants to see how lifestyle changes influence the anthropometric markers and the quality of life over timeline.


Figueroa JP, Harris MA, Duncan JP, Tulloch-Reid MK. Hypertension control: The Caribbean needs intervention studies to learn how to do better. West Indian Medical Journal. 2017;66(1):01-03. [crossref]
Ferguson TS, Tulloch-Reid MK, Gordon-Strachan G, Hamilton P, Wilks RJ. National health surveys and health policy: Impact of the Jamaica health and lifestyle surveys and the reproductive health surveys. West Indian Medical Journal [Internet]. 2012;61(4). Available from: [crossref] [PubMed]
World Health Organization. Noncommunicable diseases country profiles 2018. Available from:
Chaturvedi N, McKeigue PM, Marmot MG. Resting and ambulatory blood pressure differences in Afro-Caribbeans and Europeans. Hypertension [Internet]. 1993;22(1):90-96. Available from: [crossref] [PubMed]
Buttar HS, Li T, Ravi N. Prevention of cardiovascular diseases: Role of exercise, dietary interventions, obesity and smoking cessation [Internet]. Experimental and Clinical Cardiology. 2005;10(4):229-49. Available from: /pmc/articles/PMC2716237/.
Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global sodium consumption and death from cardiovascular causes. New England Journal of Medicine [Internet]. 2014;371(7):624-34. Available from: [crossref] [PubMed]
Joffres MR, Campbell NRC, Manns B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Canadian Journal of Cardiology [Internet]. 2007;23(6):437-43. Available from: /pmc/articles/PMC2650661/. [crossref]
Gómez-García A, Nieto-Alcantar E, Gómez-Alonso C, Figueroa-Nuñez B, Álvarez-Aguilar C. Parámetros antropométricos como predictores de resistencia a la insulina en adultos con sobrepeso y obesidad. Atencion Primaria [Internet]. 2010;42(7):364-71. Available from: [crossref] [PubMed]
Esler M. The sympathetic system and hypertension. American Journal of Hypertension [Internet]. 2000;13(6 II SUPPL.). Available from: [crossref]
Harris MA, Ferguson TS, Figueroa JP. Improved hypertension control among primary care patients in jamaica between 1995 and 2012. Global J Med Pub Health. 2016;5:99-102.
A global brief on hypertension: Silent killer, global public health crisis: World Health Day 2013 [Internet]. [cited 2021 Jun 23]. Available from:
Collins R, Peto R, MacMahon S, Godwin J, Qizilbash N, Hebert P, et al. Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: Overview of randomised drug trials in their epidemiological context. The Lancet [Internet]. 1990;335(8693):827-38. Available from: [crossref]
Lee CMY, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: A meta-analysis [Internet]. Journal of Clinical Epidemiology. J Clin Epidemiol; 2008;61(7):646-53. Available from: [crossref] [PubMed]
Berber A, Gómez-Santos R, Fanghänel G, Sánchez-Reyes L. Anthropometric indexes in the prediction of type 2 diabetes mellitus, hypertension and dyslipidaemia in a Mexican population. International Journal of Obesity [Internet]. 2001;25(12):1794-99. Available from: [crossref] [PubMed]
Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, et al. Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults [Internet]. J Intern Med. 2003;254(6):555-63. Available from: [crossref] [PubMed]
Zhou Z, Hu D, Chen J. Association between obesity indices and blood pressure or hypertension: Which index is the best? Public Health Nutrition [Internet]. 2009;12(8):1061-71. Available from: [crossref] [PubMed]
Ko GTC, Chan JCN, Woo J, Lau E, Yeung VTF, Chow CC, et al. Simple anthropometric indexes and cardiovascular risk factors in Chinese. International Journal of Obesity [Internet]. 1997;21(11):995-1001. Available from: [crossref] [PubMed]
Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 05 could be a suitable global boundary value [Internet]. Nutr Res Rev. 2010;23(2):247-69. Available from: [crossref] [PubMed]
Li WC, Chen IC, Chang YC, Loke SS, Wang SH, Hsiao KY. Waist-to-height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults. European Journal of Nutrition [Internet]. 2013;52(1):57-65. Available from: [crossref] [PubMed]
Hsieh SD, Yoshinaga H. Waist/Height ratio as a simple and useful predictor of coronary heart disease risk factors in women. Internal Medicine [Internet]. 1995;34(12):1147-52. Available from: [crossref] [PubMed]
Metcalfe C. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th edn. Wayne W. Daniel, Wiley, 1999. No. of. pages: xiv+755+appendices. Price: £28.95. ISBN 0-471-16386-4. Statistics in Medicine [Internet]. 2001;20(2):324-26. Available from:<324::AID-SIM635>3.0.CO. 3.0.CO;2-O>[crossref]
Nishida C, Barba C, Cavalli-Sforza T, Cutter J, Deurenberg P, Darnton-Hill I, et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet [Internet]. 2004;363(9403):157-63. Available from: [crossref]
Rajput A, Gupta UK, Tzivion G, Rajput R. Determining new anthropometric markers for screening type 2 DM in a Caribbean region. IJSR [Internet]. 2021;10(4):58-61. Available from: [crossref]
Mansour AA, Al-Jazairi MI. Cut-off values for anthropometric variables that confer increased risk of type 2 diabetes mellitus and hypertension in Iraq. Archives of Medical Research. 2007;38(2):253-58. [crossref] [PubMed]
Wang Q, Wang Z, Yao W, Wu X, Huang J, Huang L, et al. Anthropometric indices predict the development of hypertension in normotensive and pre- hypertensive middle-aged women in Tianjin, China: A prospective cohort study. Medical Science Monitor [Internet]. 2018;24:1871-79. Available from: [crossref] [PubMed]
Khader Y, Batieha A, Jaddou H, El-Khateeb M, Ajlouni K. The performance of anthropometric measures to predict diabetes mellitus and hypertension among adults in Jordan. BMC Public Health [Internet]. 2019;19(1):01-09. Available from: [crossref] [PubMed]
Lee JW, Lim NK, Baek TH, Park SH, Park HY. Anthropometric indices as predictors of hypertension among men and women aged 40-69 years in the Korean population: The Korean Genome and Epidemiology Study. BMC Public Health [Internet]. 2015;15(1):01-07. Available from: [crossref] [PubMed]
Gupta S, Kapoor S. Optimal cut-off values of anthropometric markers to predict hypertension in North Indian population. Journal of Community Health [Internet]. 2012;37(2):441-47. Available from: [crossref] [PubMed]
Sarry El Din AM, Zaki ME, Kandeel WA, Mohamed SK, el Wakeel KH. Cut-Off values of anthropometric indices for the prediction of hypertension in a sample of Egyptian adults. Open Access Macedonian Journal of Medical Sciences [Internet]. 2014;2(1):89-94. Available from: [crossref]
Ramezankhani A, Kabir A, Pournik O, Azizi F, Hadaegh F. Classification-based data mining for identification of risk patterns associated with hypertension in Middle Eastern population A 12-year longitudinal study. Medicine (United States) [Internet]. 2016;95(35). Available from: [crossref] [PubMed]
Shi J, Yang Z, Niu Y, Zhang W, Lin N, Li X, et al. Large thigh circumference is associated with lower blood pressure in overweight and obese individuals: A community-based study. Endocrine Connections [Internet]. 2020;9(4):271-78. Available from: /pmc/articles/PMC7159266/. [crossref] [PubMed]
Suvila K, Langén V, Cheng S, Niiranen TJ. Age of hypertension onset: Overview of research and how to apply in practice [Internet]. Current Hypertension Reports. Springer. 2020;22(9):01-08. Available from: [crossref] [PubMed]

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Date of Submission: May 14, 2021
Date of Peer Review: Jun 03, 2021
Date of Acceptance: Jul 04, 2021
Date of Publishing: Aug 01, 2021

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: May 15, 2021
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