The Socio-Demography, Clinical Characteristics and The Prevalence of Cardiovascular Risk Factors among A Group Of Elderly Hypertensive Patients Followed up at A Tertiary Care Hospital in Sri Lanka

Background : Hypertension is one of the most prevalent risk factors for myocardial infarction, strokes, congestive cardiac failure and chronic kidney disease (CKD)and its prevalence is significantly higher inthe elderly population. Objectives : To assess the demography, various presentations and the prevalence of risk factors among elderly hypertensive patients followed up in a tertiary care hospital in Sri Lanka. Materials and Methods : This was a cross sectional descriptive study involving 250 patients whose age was 60 years or above on antihypertensives for at least 6 months. Results : Approximately 65.2% of the study population was female. The mean age was 70.17.Dizziness and chest pain were the most prevalent symptoms. The mean age at first detection was 58.17 years. Mean SBP and DBP were 128.5mmHg and 81.14mmHg respectively. The prevalence of alcohol consumption and smoking among men were 70.1% and 72.4% respectively. Approximately 54.7% were either overweight or obese. Approximately 81.6% females and 41.4% males had a waist circumference of more than the risk level with p-value<0.05. Approximately 36% had diabetes mellitus and 27.6% of the patients had at least one parent and 36.8% had at least one sibling diagnosed with hypertension. Approximately 61.3% of the patients had adequate levels of physical activity while 31.8% had IHD,11.5% had stroke and 3.8% had CKD. Conclusion : Dizziness and chest pain were the most disturbing symptoms while abdominal obesity among females,and alcohol consumption and smoking among males were the major risk factors in elderly hypertensive patients DOI : Coming Soon Corresponding author: Dr. Udaya Ralapanawa, Consultant Physician and Senior Lecturer in Medicine, Professorial Medical Unit, Teaching Hospital, Peradeniya, Sri Lanka ,Email Id : udayapralapanawa@yahoo.com Running Title: Study on cardiovascular risk factors among elderly hypertensive


Background
Hypertension is one of the most prevalent and important modifiable cardiovascular risk factors for myocardial infarction, strokes, congestive cardiac failure, renal insufficiency and peripheral vascular disease (1,2,3). Hypertension in the elderly, i.e. systolic blood pressure (SBP) 140 or above and diastolic blood pressure (DBP) 90 or above in patients aged 60 years or more is considered to be a major factor that increases the mortality and morbidity in the elderly population (4,5). Nevertheless, a considerable percentage of older persons with hypertension are not detected or are not adequately treated for hypertension. (6) Hypertension in the elderly is important in many ways. The aging population has become a major concern for the whole world. The number of people aged 65 orabove, mainly in the developing countries of the worldis expected to increase from an estimated 524 million in 2010 to nearly 1.5 billion in 2050 (7). Systolic blood pressure (SBP) tends to increase with age (8,9).
The pathophysiology behind this would be the arterial stiffness, intimal hyperplasia and non-compliance of the vasculature (9,10,11). Therefore, the prevalence of hypertension among the elderly population appears to be higher compared to the younger age groups. The prevalence of other chronic diseases and their risk factors, diabetes mellitus, dyslipidemia (12,13),being overweight and obesity too is higher in the elderly (14).
In addition, the elderly are more likely to have been exposed to certain life style risk factors for hypertension such as poor dietary habits, lack of physical activity, smoking and alcohol consumption simply due to their age (15).
Hypertension is considered a silent killer. This is due to the fact that most of the patients remain asymptomatic and are usually diagnosed at screenings, as an incidental finding or when presenting with a complication of this disease (5,16 Buddhists followed by Moors. Majority of the females were widowed (Table 2).
It is a common belief that hypertension does cause symptoms. When such symptoms are experienced most think it is due to elevated blood pressure. Majority of the patients complained of or had dizziness as the foremost symptom and a majority of the patients had chest pain as a minor symptom (Table 3).
There was no significant difference in male and female groups in regard to the mean age at first detection of hypertension and current mean SBP (Table   4). Mean SBP and pulse pressure showed a peak in the 70 -74 age group while the mean DBP continuously decreased with age ( Table 5). had none of these major diseases (Table 9).

Discussion
According to the census of 2012; the population aged 60 years or more is 12.4% in Sri Lanka and it is expected toreach 24.8% in 2041(24).The prevalence of hypertension and its associated co-morbidities increase with age and it is one of the major factors contributing to the morbidity and mortality of the elderly.     shown a significant association of major complications with the male sex (42).
There were some limitations in this study; the prevalence of major modifiable risk factors was reported as low due to the majority of the subjects being female.
Further, selected subjects may not be a representative sample of the general population as this was a single station study.
Even though there have been previous studies in Sri Lanka to assess the prevalence of hypertension and risk factors in the general population, this is the first study that focused on the elderly age group. Also,we could assess the prevalence of various presentations of hypertension which might be useful in early identification of patients and to assess the control of the disease.

Conclusion
We have found that dizziness and chest pain were common symptoms among the elderly age group, and smoking and alcohol consumption among males.
Abdominal obesity among females was another major risk factor. These areas need to be addressed to improve public awareness in order to detect early hypertension and prevent its devastating complications.

Consent for Publication
Not applicable.

Availability of Data and Material
The dataset generated or analyzed during the current study are available from the corresponding author on reasonable request.

Competing Interests
We declare that we have no competing interests.

Funding
The researchers did not receive internal or external sources of funding.