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Research Article
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To Investigate the Relation of Hypertension and Anthropometric Measurement among Elderly in Malaysia
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A.L. Latiffah
and
P. Hanachi
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ABSTRACT
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This study aimed to determine the association between
anthropometric measurement and dyslipidemia and their association with
hypertension among older people. A cross sectional study was done among
the residents in two old folks homes (Rumah Seri Kenangan Cheras and Little
Sisters of the Poor) in urban Malaysia using a pre-tested guided questionnaire.
Measurements taken were the blood pressure level, height and weight measurement
and lipid profile. There were 92 respondents participated in the study.
The prevalence of hypertension was 51.1%. The study found significant
association between anthropometric measurement and hypertension although
there was no difference in waist hip ratio measurement among hypertensive
and normotensive individuals. Level of total cholesterol, LDL-C and triglycerides
were significantly higher among hypertensive individuals compared to normotensive
individuals. The prevalence rate of hypertension among residents in this
study is higher compared to the national prevalence rate among the older
adults. Appropriate invention programmes should be reinforced to reduce
the complications of hypertension especially among institutionalized elderly.
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INTRODUCTION
Hypertension has challenged the public health around the world because
of its high prevalence. It affects 1 billion worldwide (Chobanian, 2003)
and 29.9% Malaysian adult aged 30 years and above (NHMS, 1997). Hypertension
also act as a risk factor for stroke and coronary heart disease (the leading
cause of death in Malaysia) and it is also known as a silent killer. Its
numerous cases are not detected as a result of lack of routine check up
(Gold and Franks, 1990; Jeyamalar, 1991). Elderly are especially at risk
for hypertension and its related morbidity and mortality seeing that ageing
is associated with health problem (Latiffah et al., 2008). Older
people experience physiological and biological decline and they need special
management because of higher dependency (Gold and Franks, 1990; Latiffah
et al., 2005). As age increases, the structure of heart and vessel
also experience changes for both men and women. Thus an increase in systolic
blood pressure (which were common among older people) sometimes treated
as a part of ageing instead of disease (Haslam, 2008). A recent report
described associations between overweight and obesity and the prevalence
of chronic conditions including high blood pressure and high blood cholesterol
levels. Associations between obesity and high blood pressure, high blood
cholesterol and low levels of high density lipoprotein-cholesterol (Brown
et al., 2000) HDL-C) have been shown in men and women and in diverse
race/ethnic groups. This study aimed to determine the association between
obesity, dyslipidemia and hypertension among older people.
MATERIALS AND METHODS
This cross sectional study was conducted in two old folk`s home around
the Klang Valley, Malaysia from June to August, 2005. One hundred and
sixty one residents of two old folk`s homes, 92 were eligible for the
study. All subjects were given informed consent thus giving a 100% of
response rate. This study consisted of two categories. The first category
was a descriptive research involving measurement of blood pressure, biochemical
assay in blood sample followed by a brief face to face interview. The
second category was a qualitative data to obtain information related to
gender, marital and smoking behaviour.
Present study sample was limited to elderly aged 60 and above regardless
sex and race, who able to communicate, not ribbed bed or on wheel chair,
not demented, no hearing problem. Ethical committee of Faculty Medicine
and Health Science, University Putra Malaysia approved this study.
The participants were interviewed in the first half an hour using a pre-tested
and structured questionnaire administered by an interviewer to collect
information on socio-demographic variables, history of self-reported diagnosis
hypertension, dietary habits, history of smoking, stress level and level
of awareness. There were 92 respondents participated in the study. At
the end of the interview, heights, weights and blood pressure were measured
according the NHBP (1993).
Waist circumference was measured in a horizontal plane at the level of
natural waist that was the narrowest part of the torso. Hip circumference
was measured at the largest protrusion of the buttock without compressing
the skin (Lohman et al., 1991).
Calculated body mass index (BMI), waist circumference and waist hip ratio
(WHR) used as Indicator of obese and risk of co-morbidities (Keys et
al., 1972; Seidell et al., 1990). To determine the cut off
point for BMI were measured according the Douketis et al. (1999)
and WHO recommendation to determine the cut off point for waist circumference
and WHR (WHO, 1998). Subject with high risk are those with waist circumference
more than 85 cm for male and more than 80 cm for female or WHR more than
0.9 for male and 0.85 for female.
Fasting blood samples were taken to measure the serum lipid and blood
glucose according to the standard enzymatic techniques. Cobas Mira Chemistry
Analyzer determined the biochemical analyses for lipid profiles and glucose.
Classification of the blood serum lipid profiles was based on the National
Cholesterol Education Programme (NCEP, 2002). Criteria for individuals
with high-risk of hypertension are those with cholesterol level of ≥5.2
mmol L-1 or LDL-C > 4.13 mmol L-1 or triglycerides
of ≥1.7 mmol L-1 or HDL > 1.3 mmol L-1 for
male and >1.40 mmol L-1 for female.
Blood pressure was measured based on recommendation by Malaysian Clinical
Practice Guideline (2002). Blood pressure was measured after 30 min rest
in the right arm supported on a table at heart level with the patient
seated. They were also abstained from smoking or ingested caffeine within
that time. Three readings were taken and their mean was recorded as the
actual pressure. Hypertension for this study was a systolic pressure of
greater than 140 mmHg and or diastolic pressure of above 90 mmHg regardless
of age. Isolated systolic hypertension as SBP >140 mmHg and DBP <90
mmHg was also noted (JNC VI, 1997).
Data analysis: All statistical analysis were performed with using
SPSS 10.0 (Statistical Package for Social Science). Descriptive statistics
including means and SDs for the outcome variables of interest were computed.
The probability levels of significance reported was based on the 2-tailed
t-test. Correlations test were used to determine the association between
hypertension and the different variables.
RESULTS
Population characteristics: Table 1 shows the
mean age was 73.49 ± 8.65 years, ranged from 62 to 92 years old.
The sample included a greater proportion of male (41.3%) than female (58.7%),
widow/widower (56.5) than single (43.5), Chinese (44.6%), Indian (28.3%)
and Malay (25.0%). Majority of them never receive any formal education
(85.9%) and do not have any source of income (88.0%).
Prevalence of hypertension: Table 2 summarized
the findings on the proportion of hypertension based on risk in anthropometric
measurement and lipid profile whereas Table 3 provided
similar findings based on differences in median or mean. Compared to normal
anthropometric measurement, the percentage of hypertension was significantly
higher among elderly with high-risk waist circumference (83 vs 17%, p<0.05)
and WHR (53.2 vs 46.8%, p<0.05). Hypertension was also significantly
more prevalent among overweight and obese subject compared to normal BMI
(68.1 vs 31.9%, p<0.05).
The study has found significant association between hypertension and
dyslipidemia based on total cholesterol level, LDL-C and triglycerides
(p<0.05) but not with HDL-C (p = 0.141) although the percentage of
hypertensive individuals was higher among those with normal HDL-C (55.3%
vs 44.7%).
Table 1: |
Socio-demographic characteristics of the respondent
(n = 92) |
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Data were expressed as Mean ± SD |
Table 2: |
Hypertension based on anthropometric measurements and
lipid profiles |
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*p-value is significance if (p<0.05) or (p<0.01) |
Table 3: |
Mean of anthropometric measurements and lipid profile
based on hypertension |
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**Presented in Median (IR) and non-parametric test Mann
Withney-U, *p-value is significance if (p<0.05) or (p<0.01),
Data were expressed as Mean ± SD |
Weight, height, waist circumference, BMI and total cholesterol data were
normally distributed. Table 3 shows the comparison of
anthropometric measurement and lipid profile between hypertensive and
normotensive individuals. Hypertensive individuals significantly have
higher anthropometric measurement in weight (p<0.05), waist circumference
(p<0.001), hip circumference (p<0.003) and BMI (p<0.001). Median
for WHR was higher among hypertensive individuals compared to normotensive
individuals (0.94 vs 0.90 p = 0.098).
Based on lipid profile, hypertensive individuals significantly has higher
total cholesterol level (p<0.001), LDL-C (p<0.05) and triglycerides
(p<0.05) compared to normotensive individuals (Table
3). As mention earlier, the level of HDL-C did not contribute to the
prevalence of hypertension despite the fact that the median was higher
among the hypertensive individuals compared to the normotensive individuals
(1.26 vs 1.19 p = 0.139).
DISCUSSION
The prevalence of hypertension in the study was higher compared to Malaysia`s
National Health and Morbidity Survey II (NHMS II) data (Lim et al.,
2000; Srinivas et al., 1998) data among rural elderly Malaysian.
So far, there are no official references in the prevalence of hypertension
among elderly in Malaysia. Present study population was not representative
to be compared with NHMS II, since only 16 % of population in NHMS II
were aged 60 years and above. Other reasons could be due to the smaller
sample size and the difference in the male to female ratio in this study.
Previous studied (Woo et al., 2002; Olinto et al., 2004;
Cox et al., 1998) found that hypertension, as the antecedent for
CVD, was associated with the increasing measurement of anthropometric
measurement. This present study also found a positive association between
waist circumference and hypertension (Janssen et al., 2002; Abolfotouh
et al., 2001; Sabuncu et al., 1999). Cross sectional study
does not provide information on the sequence of the risk factor development
and cause effect relationship cannot be inferred. However, our findings
are consistent with the other cross sectional, prospective, retrospectives
and clinical studies that show cardiovascular risk factors are more prevalent
among overweight and obese people. According to Yusuf et al. (2005)
study suggested that abdominal obesity, such waist circumference and waist
hip ratio, was better risk indicator for CVD compared to BMI. Waist circumference
cut-offs are more sensitive than BMI cut-offs in predicting the risk of
CVD (Zhu et al., 2005). BMI provides an estimate of weight correction
for height while the WHR estimates abdominal fat mass(Gaveler and Rosenblum,
2003). However, we could not provide evidence to suggest that the measurement
for waist hip ratio among hypertensive patients were higher compared to
the normotensive individuals.
In general, the prevalence of hypertension and high blood cholesterol increase
with the increasing of BMI, as does the combined prevalence of both hypertension
and dyslipidemia (Brown et al., 2000). Our study calculates the association
between hypertension and dyslipidemia disregarding BMI. However, the results
show that the level of total cholesterol, LDL-C and triglycerides are higher
among hypertensive individuals. Lipid abnormalities, which are hypercholesterolemia,
high LDL-C level, low HDL-C level and hypertriglyceridemia, are the most important
risk factors for atherosclerotic complication of hypertension especially in
patients aged older than 65 years (Castelli et al., 1986; Carlsson et
al., 1999). Surprisingly although not statistically significant, the HDL-C
level is higher among the hypertensive individuals. This result does not confirm
the evidence that HDL-C as a marker for cardiovascular disease (Després
et al., 2000; Assmann et al., 1996; Rubins et al., 1995).
CONCLUSION
Prevention of hypertension is important, given that treatment of established
hypertension is only partly effective in reducing the associated morbidity
and mortality. Primary prevention focusing on efforts to prevent the development
of the disease and altering the hypertension risk factors have to be implemented.
Secondary prevention should be carried out as well by focusing on slowing
the progression of the disease after a diagnosis. Government should increase
the public awareness on this establishing disease and the advantages on
healthy lifestyle. Screening CVD factors among older adults above 50 years
old is an important preventive measure. More research, especially longitudinal
research should be carried out on cardiovascular disease especially among
institutionalized elderly since research on this field is lacking. We
need to do something through further studies to look into the management
and treatment of hypertensive in the Malaysian rural and urban communities.
ACKNOWLEDGMENTS
The authors would like to acknowledge the Medicine and Health Sciences
Faculty of UPM for supporting this study.
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