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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 2  |  Page : 45-48

Magnitude and correlates of hypertension among geriatric women in a resettlement colony of Delhi


1 Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
2 School of Medical Science and Research, Sharda University, Greater Noida, Uttar Pradesh, India

Date of Web Publication18-Jul-2017

Correspondence Address:
Tulika Singh
33/23, 1st Floor, West Patel Nagar, New Delhi - 110 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_16_17

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  Abstract 

Background: Hypertension is one of the most important causes of mortality and morbidity in the geriatric age group.
Objective: The objective was to study the magnitude and correlates of hypertension among geriatric women in a resettlement colony of Delhi.
Materials and Methods: A community-based, cross-sectional study for the duration of 1 year was conducted among 512 geriatric women (≥60 years). Demographic characteristics and behavioral risk factors were determined by interview, and the participants underwent physical examination (blood pressure, height, weight, and waist circumference). Chi-square and unpaired t-tests were employed to study the association between risk factors and hypertension followed by multivariate regression analysis.
Results: The prevalence of hypertension was 16.01%. Age, marital status, socioeconomic status, financial dependence, tobacco and alcohol use, physical activity, coexisting diabetes, body mass index, and waist circumference were significantly associated with hypertension on univariate analysis. In multivariate analysis, tobacco use, coexisting diabetes, and obesity were significant explanatory variables for hypertension.
Conclusion: This study identifies some of the major factors associated with hypertension in geriatric women. Therefore, community-based approaches for improving awareness regarding hypertension and its risk factors and lifestyle modifications are essential to reduce the burden.

Keywords: Geriatric, hypertension, obesity, women


How to cite this article:
Singh T, Nagesh S. Magnitude and correlates of hypertension among geriatric women in a resettlement colony of Delhi. Int J Non-Commun Dis 2017;2:45-8

How to cite this URL:
Singh T, Nagesh S. Magnitude and correlates of hypertension among geriatric women in a resettlement colony of Delhi. Int J Non-Commun Dis [serial online] 2017 [cited 2017 Aug 23];2:45-8. Available from: http://www.ijncd.org/text.asp?2017/2/2/45/211075




  Introduction Top


The geriatric age group constitutes 8.1% of India's population and is one of the most rapidly expanding segments of population.[1] The increase in longevity due to improvement in health care has led to relentless increase in geriatric population as well as related morbidities such as cardiovascular (CVS) diseases. Worldwide, women live longer than men leading to a process called the “feminization of later life” and are more vulnerable due to biological, social, cultural, and economic factors.

Hypertension has emerged as an important public health problem worldwide. Globally, CVS disease accounts for approximately 17 million deaths a year.[2] Of these, complications of hypertension account for 9.4 million deaths worldwide every year. Hypertension is responsible for at least 45% of deaths due to heart disease and 51% of deaths due to stroke. According to recent estimates, Southeast Asia has a prevalence of 24.7%.[3] Various epidemiological studies have indicated rising prevalence of hypertension in India as well.[4],[5]

After menopause, the prevalence of hypertension in women is higher than that in men, and CVS disease is the leading cause of death in women.[6] The increasing prevalence of hypertension is attributed to population growth, aging, and behavioral risk factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight, and exposure to persistent stress.[7] Several studies have firmly established that treatment of hypertension in elderly significantly reduces CVS morbidity and mortality.[4],[8]

In India, with increase in geriatric population, the prevalence of hypertension is bound to increase. Yet, there is a scarcity of studies assessing the prevalence of hypertension in geriatric women. In our study, we investigated the magnitude and correlates of hypertension in a cross-section of geriatric women of a resettlement colony of Delhi.


  Materials and Methods Top


Study design

A community-based, cross-sectional study for a period of 1 year was carried out among geriatric women in the resettlement colony of Kalyanpuri.

Sampling

Using the formula n = 4pq/l2, taking prevalence as 43.5%,[9] the sample size came out to be 509. Out of 11 blocks of Kalyanpuri, six were randomly selected and all geriatric women residing in these blocks were enrolled in the study. Thus, the final sample size was 512.

Study tools and variables

A pretested structured questionnaire that sought information on sociodemographic characteristics, medical history, tobacco/alcohol use, and physical activity was administered. Participants were also subjected to anthropometric and blood pressure measurements using standardized procedures.

Methodology

After obtaining informed written consent, participants were interviewed using pretested questionnaire. During the interview, two measurements of blood pressure using a digital blood pressure monitor (OMRON) were obtained in right arm sitting position with rest of at least 5 min. The first measurement was recorded after obtaining demographic information from the subject, and the second measurement was recorded after a brief clinical examination. The average of two readings of the systolic and diastolic blood pressure was used as the blood pressure of the participant. Participants were categorized as hypertensive if they had a systolic blood pressure of ≥140 mm of Hg or/and diastolic blood pressure of ≥90 mm of Hg or those taking antihypertensive medication.

Statistical analysis

Data were entered in Excel sheet, and statistical analysis was performed using SPSS version 17.0 (IBM SPSS Inc., NY, USA). Chi-square test and unpaired t-test for the categorical and continuous variables were employed, respectively, to study the association between various parameters. Further, variables with P < 0.05 in univariate analysis were then included in the multivariate logistic regression analysis.


  Results Top


In our study, 82 (16.01%) geriatric women were found to be hypertensive and newly diagnosed hypertension was 5.1%. [Table 1] shows the categorical sociodemographic attributes of geriatric women with reference to their blood pressure status. A significant association was observed between hypertension and marital status (P = 0.001), socioeconomic status (P = 0.001), financial dependence (P = 0.008), presence of tobacco use (P< 0.001), presence of alcohol use (P< 0.001), absence of physical activity (P = 0.007), and coexisting diabetes (P< 0.001).
Table 1: Categorical sociodemographic attributes of geriatric women

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[Table 2] shows the continuous sociodemographic variables of geriatric women with reference to their blood pressure status. The mean age group of hypertensive and normotensive geriatric women was 66.06 ± 5.24 and 64.33 ± 5.87, respectively. There was a significant difference (P< 0.001) in the body mass index (BMI) and waist circumference of hypertensive and normotensive geriatric women.
Table 2: Continuous sociodemographic attributes of geriatric women

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[Table 3] represents the results obtained by multivariate analysis. The odds were higher in geriatric women who used tobacco (OR 1.372 [95%CI= 1.016-5.199], P = 0.002) and who had co-existing diabetes (OR 2.832 [95% CI = 1.146-5.077], P = 0.041). The OR of BMI and waist circumference in hypertensive geriatric women was 3.011 (95% CI = 1.078–8.407) and 3.872 (95% CI = 1.488–10.073), respectively.
Table 3: Multivariate analysis for predictors of hypertension in geriatric women

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  Discussion Top


In the present study, prevalence of hypertension among geriatric women was 16.01%. A similar prevalence of 15.2% was reported by Goswami et al. in Delhi.[10] Hypertension was present in all participants having CVS morbidity according to the Joint National Committee-7 criteria.[11] It ranged from 12.9% to 59.1% in various studies.[10],[12],[13],[14],[15],[16] The difference in prevalence of hypertension may be due to variation in tool, methodology, nature of population itself, accessibility to health services and observer bias, etc., Various studies have shown a higher prevalence in women as compared to men in the geriatric age group.[3],[11],[13]

BMI and waist circumference, measures related to overweight and obesity, were significantly higher in hypertensive participants than in normotensive participants. These findings were similar to previous studies.[5],[17],[18] Our study did not find an association between physical activity and hypertension on multivariate analysis. This could be due to the population studied as geriatric women are already suffering from various musculoskeletal morbidities and cannot carry out regular physical activity and hence did not give a history of regular physical activity.

Diabetes was associated with increased odds of being hypertensive. Various studies have revealed similar results.[5],[17],[18],[19] The coexistence of hypertension and diabetes might be because of sharing common risk factors such as smoking, alcohol consumption, unhealthy diets, and physical inactivity.

These findings clearly reflect the multifactorial nature of hypertension similar to other noncommunicable diseases. Several of these factors could be targeted to improve their health status.


  Conclusion Top


This study determined a high prevalence of hypertension and its association with various lifestyle-related factors. Therefore, community-based approaches for improving awareness regarding hypertension and its risk factors and lifestyle modifications are essential to reduce the burden.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ministry of Health & Family Welfare, Government of India. National Programme for the Health Care of Elderly. Operational Guidelines 2011-2012. Ministry of Health and Family Welfare, Government of India, New Delhi; 2011.  Back to cited text no. 1
    
2.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. Acomparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2224-60.  Back to cited text no. 2
    
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Global Health Observatory Data Repository. Available from: http://www.apps.who.int/gho/data/view.main.2540?lang=en. [Last accessed on 2017 Jan 07].  Back to cited text no. 3
    
4.
Moser KA, Agrawal S, Davey Smith G, Ebrahim S. Socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in India: Analysis of nationally-representative survey data. PLoS One 2014;9:e86043.  Back to cited text no. 4
    
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Kokiwar PR, Gupta SS, Durge PM. Prevalence of hypertension in a rural community of central India. J Assoc Physicians India 2012;60:26-9.  Back to cited text no. 5
    
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Lima R, Wofford M, Reckelhoff JF. Hypertension in postmenopausal women. Curr Hypertens Rep 2012;14:254-60. Doi:10.1007/s11906-012-0260-0.  Back to cited text no. 6
    
7.
World Health Organization. A Global Brief on Hypertension, Silent Killer, Global Public Health Crisis; 2013, 2014. Available from: http://www.apps.who.int/iris/bitstream/10665/79059/1/WHO_DCO_WHD_2013.2_eng.pdf. [Last accessed on 2017 Jan 07].  Back to cited text no. 7
    
8.
Shrivastava SR, Shrivastava PS, Ramasamy J. The determinants and scope of public health interventions to tackle the global problem of hypertension. Int J Prev Med 2014;5:807-12.  Back to cited text no. 8
    
9.
Farag YM, Mittal BV, Keithi-Reddy SR, Acharya VN, Almeida AF, CA, et al. Burden and predictors of hypertension in India: Results of SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol 2014;15:42. Doi:10.1186/1471-2369-15-42  Back to cited text no. 9
    
10.
Goswami A, Reddaiah VP, Kapoor SK, Singh B, Dey AB, Dwivedi SN, et al. Health problems and health seeking behavior of the Rural aged. Indian J Gerontol 2005;19:163-80.  Back to cited text no. 10
    
11.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA 2003;289:2560-72.  Back to cited text no. 11
    
12.
Chakraborty S. Health Seeking Behavior of Aged Population of a Rural Block in West Bengal, Working Paper No. 8. Achuta Menon Center for Health Science Studies, Thiruvananthapuram, Kerala; 2005.  Back to cited text no. 12
    
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Jain NC, Pawar AB, Ravjibhai H, Bansal RK. Morbidity profile of elderly peo-ple in slums of Surat City. National J Community Med 2010;1:53-4.  Back to cited text no. 13
    
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Agrawal S, Deo J, Verma AK, Kotwal A. Geriatric health: Need to make it an essential element of primary health care. Indian J Public Health 2011;55:25-9.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Manda PK, Chakrabarty D, Manna N, Sarmila Mallik, Chatterjee C. Disability among geriatric females: An uncared agenda in rural India. Sudanese Journal of Public Health 2009;4:376-82.  Back to cited text no. 15
    
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Prakash R, Choudhary SK, Singh US. A study of Morbidity pattern among geriatric population in an urban area of Udaipur Rajasthan. Indian J Community Med 2004;29:35-40.  Back to cited text no. 16
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Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in Rural and Urban communities in high-, middle-, and low-income countries. JAMA 2013;310:959-68.  Back to cited text no. 17
    
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Kaur P, Rao SR, Radhakrishnan E, Rajasekar D, Gupte MD. Prevalence, awareness, treatment, control and risk factors for hypertension in a Rural population in South India. Int J Public Health 2012;57:87-94.  Back to cited text no. 18
    
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Dhungana RR, Pandey AR, Bista B, Joshi S, Devkota S. Prevalence and associated factors of hypertension: A community-based cross-sectional study in municipalities of Kathmandu, Nepal. Int J Hypertens 2016;2016:1656938.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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