Prevalence and Factors Associated with Hypertension : A Cross-Sectional Study among Elderly Population in Pokhara Metropolitan

Received on: Dec. 15th, 2020. Accepted on: Jun. 9th, 2021. Published on: Aug. 16th, 2021. Abstract Aims: hypertension (HTN) is rapidly emerging as a public health problem among elderly in developing countries. The objective of this study was to assess the prevalence of hypertension and its associated factors among the elderly in Pokhara Metropolitan, Nepal. Methods: a cross-sectional analytical study was carried out to assess hypertension among 323 community dwelling elderly in Pokhara Metropolitan from October 2019 to March 2020. Quota sampling was used to collect the samples. Elderly those who were attending hospitals or with any serious medical conditions were excluded from the study. Face to face interview was done for data collection and anthropometric measurements, and semi structured standard STEPS questionnaires were used as data collection tools. Data were entered in Epi DATA [Version 3.1] and analyzed using SPSS [Version 20] as per data analysis plan. Bivariate logistic regression analysis were conducted and statistical significance was declared at a p-value ≤ 0.05. Results: prevalence of hypertension was reported among 34.4 percent (Male: 39.3%, Female 29%) elderly in Pokhara Metropolitan. The higher proportion of hypertensive cases were in age group 60-69 years (36%). The prevalence of hypertension was significantly associated with ethnicity (OR= 1.74, CI: 1.07-2.83), current alcohol intake (OR= 2.56, CI: 1.30-5.05) and mental stress (OR= 2.25, CI: 1.19-4.28). Conclusion: more than one third of the elderly had hypertension. Ethnicity, current alcohol intake and mental stress are found to be factors associated with hypertension. Periodic screening for early detection of hypertension and implementing health promotion interventions to encourage behavior change among elderly may promote healthy ageing.


Background
Hypertension is rising public health problem among elderly in developing countries. 1,2 It is one of the vital risk factors for cardiovascular mortality and morbidity globally. 1,3,4 Hypertension prevalence increases with age. 5-8 Hypertension, a "SILENT KILLER", is a condition where the systolic blood pressure is equal to or above 140 mmHg and/or diastolic blood pressure is equal to or above 90 mmHg. 9,10 Hypertension is an outcome of behavioral risk factors including unhealthy diet, physical inactivity, tobacco use, poor stress management, harmful alcohol intake. 9,11,12 Other factors related to hypertension are sex, dietary salt intake, parental history of hypertension 9 , body mass index 13 , obesity (BMI>30 kg/m 2 ) and sleep duration. 14
Slightly higher proportion of hypertensive cases were seen in the current smokers (39.7%) as compared to non-smokers and difference between these groups were not statistically significant (p = 0.349).
Physical activity, family history of hypertension, sleep duration had no any significant association with hypertension (Table 2).  and northern Thailand. 13 The reason behind it may be due to recall bias in study population.

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In this study types of dietary intake didn't show significant association with hypertension; however, non-vegetarians were more hypertensive than

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vegetarian which is consistent with the findings of a study in Uttarakhand. 21 Majority of the respondents were found to never add salt before eating rather think that they consume just the right amount of salt. The prevalence of hypertension was seen high among those consuming high amount of salt than those consuming low amount of salt.
The study showed the prevalence of hypertension slightly higher among those who performed physical activity for more than 30 minutes than those performing physical activity for less than 30 minutes. On the other hand some previous studies showed higher prevalence of hypertension in subjects doing irregular physical activity in Uttarakhand, India 1 and in Brazil. 26 In this study mental stress was found to be significantly associated with hypertension (p=0.01).
The prevalence of hypertension was higher among those who had stress on a daily basis than those who had rare stress. Here, mental stress was measured by the factors: financial problem, health problem, occupational problem and family problem.

Limitations
The study was carried out in an urban population with defined methods. Hence, the findings must be utilized carefully with due considerations of methodological limitations of sampling, population targeted, accuracy of verbal reporting by elderly (recall and social desirability biases).

Conclusion
Hypertension was prevalent among one-third elderly in Pokhara Metropolitan. Ethnicity, alcohol consumption and mental stress were identified as the factors associated with hypertension.
Interventions aiming to reduce/restrict the consumption of alcohol and establishing elderly friendly service centre for health care and social support would be useful to curb down the hypertension among elderly. Periodic screening for early detection of hypertension and implementing health promotion interventions to encourage behavior change among elderly may promote healthy ageing.