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© Borgis - New Medicine 1/2004, s. 2-4
Judyta Cielecka-Piontek1,2, Arkadiusz Styszynski1, Katarzyna Wieczorowska-Tobis1
Knowledge of Risk Factors for Hypertension in the Elderly
1Department of Pathophysiology, University of Medical Sciences, Poznań, Poland
2Department of Pharmaceutical Chemistry, University of Medical Sciences, Poznań, Poland
Aim. The aim of the study was to analyze knowledge of risk factors for hypertension in elderly subjects.
Method. The study involved 154 inhabitants of one of the small towns in the Wielkopolska region, aged 65 years and older (mean age: 72.5±6.8 year). This group made up 84.1% of the elderly and geriatrics in the town. All were asked to list the risk factors for hypertension. For analysis of the results, the subjects were divided into groups of different sex (females – n=100 and males – n=54) and age (group I: age<75 and group II: age ł75).
Results. The mean number of listed risk factors was only 1.3±1.2 (range 0-9). It must be pointed out that 40 subjects (26%) did not know any risk factors and an additional 57 individuals (37%) listed only one. There was no difference between females and males in respect of the number of listed risk factors (1.3±1.2 vs 1.3±1.3, respectively). However, females knew that stress increased the risk of hypertension more often than males (54.0% vs 35.2%; p<0.05).
Conclusion. In conclusion, knowledge of the risk factors for hypertension was very poor in the studied subjects. It was not affected either by sex or by age.
The treatment of elderly persons is a problem of increasing importance, because in many countries, including Poland, those people make up a growing group in demographic structures. Population ageing is evident even in single cities e.g. in Poznań. In 1991 the percentage of elderly was 11% there, rising to 13% by 2001.
The risk of cardiovascular diseases increases very strongly with age. Organic changes in all organs, both due to physiological ageing and long term exposure to various environmental factors contribute to this process. Among the cardiovascular diseases which are more prevalent with age, hypertension affects 40 to 60% of elderly patients (1).
For many years there has been no doubt that hypertension in elderly persons should be treated (2, 3). However, pharmacotherapy for hypertension is particularly difficult in this age group. Firstly, and typical of advanced age, polypathology results in polytherapy. Secondly, both altered pharmacokinetics and pharmacodynamics due to ageing increase the risk of undesirable side effects from the applied drugs. Moreover, the low incomes of many elderly patients limit the possibility of administration of many pharmaceutical preparations. From this point of view, in elderly subjects the elimination of the risk factors for hypertension due to anti-ageing intervention is extremely important. These factors include high-sodium and high-lipid diets, smoking, obesity, stress, physical inactivity, and illnesses leading up to hypertension such as diabetes, renal, and thyroid diseases (4). The significant impact of modifiable risk factors on the evolution of hypertension is a considerable argument for the education of aged persons. Proper anti-ageing education would delay the start of pharmacological treatment, and reduce the doses of applied hypotensive drugs. Yet, it should be kept in mind that the education of elderly persons can be complicated because of reduced efficiency of the cognitive functions and, as a consequence, difficulties in understanding instructions given by the physician. Additionally, individual nutritional habits, which take their shape in earlier stages of our life, are very difficult to alter in advanced age. On the other hand, many publications report that, following proper education, it is possible to reduce the number of patients requiring pharmacological treatment for hypertension (5). Thus, it seems that the need for education is unquestionable, especially in age groups where pharmacotherapy is related to high risk.
The purpose of this study was to evaluate elderly subjects´ knowledge of the risk factors for hypertension.
Characteristics of participants
In our study we examined 154 individuals aged from 65 to 91 (mean age 72.5±6.8 years), being 100 females and 54 males (mean age of females and males was 73.0±7.1 and 71.5±6.0 years, respectively). The subjects lived in one of the small towns in the Wielkopolska region, where they made up 84.1% of the geriatric population in that town.
At the beginning, subjects were asked about their age and sex. Next, they were questioned about the risk factors for hypertension. The percentage of persons who mentioned individual risk factors was counted for each of our listed factors. The results of inquiries were analyzed in groups of persons based as follows:
a) sex – 100 females and 54 males
b) age:
– group I – subjects younger than 75 years (110 individuals)
– group II – subjects of 75 years and older (44 individuals).
The number of females and males in each of these two groups was not significantly different.
The results were presented as mean ± standard deviation. Mean values for particular groups were compared using the test for unpaired variables (Mann-Whitney test). The frequency of positive results in each of the matched groups was compared using the Fisher test. A P value of less than 0.05 was considered significant.
Knowledge of risk factors for hypertension in the studied population
The elderly subjects listed from 0 to 6 risk factors for hypertension. However, the mean number of listed factors was only 1.3±1.2. There were forty subjects (26.0%) who were unable to mention even one factor. Conversely, only two individuals (1.3%) listed six factors. The frequency of listing particular factors is shown in Figure 1. The most frequently mentioned risk factors were stress (47.4%), a high lipid diet (29.2%), and life-style (13.6%).
Fig. 1. The percentage of subjects who listed a number of risk factors for hypertension.
Knowledge of risk factors for hypertension by sexual group
Both women and men gave comparable numbers of risk factors (1.3±1.2 and 1.3±1.3 respectively). However, stress as risk was mentioned more frequently by women than by men (54.0% vs. 35.2%; p<0.05). Data concerning the frequency of listing particular factors by women and men are shown in Figure 2.
Fig. 2. The frequency of mentioning risk factors for hypertension by females and males.
The effect of age on knowledge of risk factors
The mean number of listed factors was comparable (group I – 1.4±1.3, and group II 1.1±1.0). Interestingly, as far as the two age groups were concerned the only difference between them was the frequency of listing alcohol as a risk factor. Up to 13.6% of group II and only 3.6% of group I believed that drinking alcohol might affect their blood pressure (p<0.05).
The most frequently mentioned factor was stress. This was listed by 54 persons in group I (49.9%) and 19 persons in group II (43.2%). The frequency of listing factors in both age groups is shown in Figure 3.
Fig. 3. The frequency of mentioning risk factors for hypertension in two age groups.
´It´s better to prevent than to treat´ is of special significance for elderly. This is because pharmacological treatment in this age group is associated with a high risk of side effects, especially the occurrence of iatrogenic geriatric syndromes. In the light of this, there is an increasing emphasis on non-pharmacological treatment, which requires a good knowledge of the risk factors for many pathological conditions, including hypertension. However, preventive education of the elderly presents many difficulties. This means that there is, as found, poor knowledge of the etiology of hypertension among elderly persons. In our research we have shown that the mean number of factors known was only 1.3±1.2, and as many as 26% of participants could not mention even one factor that could dispose to hypertension (Fig. 1). The maximum number of risk factors was six, but only two persons (1.3%) achieved that number. Such a poor knowledge of risk factors for hypertension confirms the results of a study carried out in the Department of Gerontology and Family Medicine at the Jagiellonian University, Cracow (6). Those authors showed that over 60% of persons with diagnosed hypertension could not describe non-pharmacological methods for the reduction of arterial pressure, and the most frequent response was high lipid diet (23% of subjects). Similar results were obtained in a study performed by Krupa-Wojciechowska and colleagues (7). This showed that one third of individuals who suffer from hypertension were not aware that being overweight is harmful, and 40% did not know about the benefits of restriction of salt intake.
In our study the most frequently mentioned risk factor was stress (Figure 2 and 3). This is interesting, especially as the possible prevalence of this condition in old age is high. This results from the effect of the losses characteristic of this period of life (economical, physical, social and family losses), which result in negative emotions. Stress affects the self-esteem, and also tends to a situation in which aged people undertake treatment reluctantly (8).
When we analyzed the influence of sex on the knowledge of risk factors, we found that both women and men listed a similarly low number of factors (1.3±1.2 and 1.3±1.3, respectively). It is commonly believed that women are more frequently willing to undertake treatment, and that they are more receptive to preventive education (9). Thus, it might be expected that women´s knowledge of risk factors would be better.
The next criterion that we considered in our analysis was age. We divided the subjects into two age groups according to the division commonly used in geriatric medicine, which distinguishes the ´young old´ and ´old old´ population. Interestingly, group I (´young old´ group) and group II (´old old´ group) listed a comparable number of factors for hypertension. It might seem that subjects from the younger group would list a higher number of factors because of a predictably better capacity of cognitive functions (10). Conversely, respondents from group II mentioned drinking of alcohol more frequently, as a factor disposing to the evolution of hypertension. This probably arises from the conviction that every misfortune follows from alcohol abuse. It cannot be precluded that the high increase in the occurance of cardiovascular diseases, accompanying senescence after the 75th year of age, results at least partly from a lack of knowledge about risk factors. The study shows that there is a necessity for the education of aged people, especially for those in the ´young old´ group, because after the 65th year the prevalence of dementia doubles every five years (11), increasing the risk of problems with memorizing.
However, it should be realized that the education of aged people is a complex and difficult problem, because of their poor flexibility and low compliance with suggested changes in their lifestyle. Despite the difficulties, evidence of the advantages of education in this age group is unquestionable.
– Knowledge of risk factors for hypertension in the elderly is poor.
– Neither sex nor age had any effect on knowledge of risk factors for hypertension.
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