Prevalence, awareness, treatment, control and correlates of prevalence and control of hypertension among older adults in Kerala: A mixed methods study

Introduction: We conducted this study among older adults with the following objectives: (1) To find out the prevalence, awareness, treatment and control of hypertension, (2) To understand the factors associated with hypertension prevalence and control.

Methods: A mixed-methods study employing a sequential explanatory design was conducted with a survey of 300 participants aged ≥60 years, and 15 in-depth interviews. Blood Pressure (BP) and waist circumference were measured using standard protocol. Survey data were analysed using univariate and multivariate procedures. In-depth interviews were analysed employing thematic analysis.

Results: Hypertension prevalence was 72.3% (95% CI = 67.1-77.2), 68.2% (CI = 61.8-74.2) were aware, 65.4% (CI = 59.0-71.6) were treated and 24% (CI = 18.6-29.9) achieved adequate control. Inadequate physical activity [(adjusted odds ratio (AOR)] = 2.34; CI = 1.19-4.59), current alcohol use (AOR = 2.28; CI = 1.06-4.91) and self-reported diabetes (AOR = 2.02; CI = 1.15-3.52) were associated with hypertension prevalence. Those who reported diabetes (AOR = 2.72, CI = 1.34-5.55), with education level up to high school (AOR = 2.58, CI = 1.11-6.00) and who were in the age group 60-70 years (AOR = 2.14, CI = 1.09-4.20) were more likely to have controlled hypertension compared to their counterparts. From the in-depth interviews it was found that availability and accessibility of services, family support, financial wellbeing, habits and beliefs and conducive environment played a role in hypertension diagnosis and management.

Discussion: Prevalence of hypertension was high in this population along with poor control. Efforts are required to improve hypertension control focussing on older adults with low education and those who are aged 70 years and above.