Prevalence of hypertension and its association With a high risk of falls in older adults
Main Article Content
Abstract
The study aimed to investigate the prevalence of hypertension and its association with a high risk of falls among older outpatients. A cross-sectional study was conducted in 529 patients aged 60 or older without cognitive impairment, who visited at the National Geriatric Hospital, Hanoi, Vietnam from March to December 2018. The rate of hypertension was 55.4% (94.5% had treated hypertension and 48.5% had controlled hypertension), every 1 in 5 patients ≥ 60 years old suffered from a high risk of falls (21%); these proportions increased with age. The percentage of patients at high risk of falls in the hypertensive group was significantly greater than that the non-hypertensive group, p < 0.001. We found a number of factors associated with high risk of falls, including: age ≥ 80 (OR 5.44; 95%CI: 2.28 - 12.96), previous history of falls (OR 3.77; 95%CI: 1.96 – 7.25), hypertension (OR 1.93; 95%CI: 1.13 - 3.28), patients with treated controlled hypertension (OR 0.42; 95%CI: 0.25 - 0.71). Hypertension is prevalent, and is associated with an increased risk of falls among older people. Hypertension treatment and targeted blood pressure control are needed to reduce fall risk.
Article Details
Keywords
Hypertension, risk of falls, Older adults
References
1. Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurology. 2016;15(9):913-924.
2. Nguyen T-P-L, Wright EP, Nguyen T-T, et al. Cost-effectiveness analysis of screening for and managing identified hypertension for cardiovascular disease prevention in Vietnam. PloS one. 2016;11(5):e0155699.
3. Yusuf S, Joseph P, Rangarajan S, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. The Lancet. 2020;395(10226):795-808.
4. Anandita M, Mehta A, Yang E, Parapid B. Older Adults and Hypertension: Beyond the 2017 Guideline for Prevention, Detection. Evaluation, and Management of High Blood Pressure in Adults. 2020;26.
5. Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Medicine. 2017;96(4).
6. Abate M, Di Iorio A, Pini B, et al. Effects of hypertension on balance assessed by computerized posturography in the elderly. Archives of gerontology and geriatrics. 2009;49(1):113-117.
7. Ozaldemir I, Iyigun G, Malkoc M. Comparison of processing speed, balance, mobility and fear of falling between hypertensive and normotensive individuals. Brazilian journal of physical therapy. 2019.
8. Panel on Prevention of Falls in Older Persons AGS, Society BG. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society. 2011;59(1):148-157.
9. Dionyssiotis Y. Analyzing the problem of falls among older people. International journal of general medicine. 2012;5:805-813.
10. EuroSafe A. Falls among older adults in the EU-28: key facts from the available statistics. In:2015.
11. Kulkarni S, Rao R, Goodman JDH, Connolly K, O'Shaughnessy KM. Nonadherence to antihypertensive medications amongst patients with uncontrolled hypertension: A retrospective study. Medicine. 2021;100(14).
12. Rosli R, Tan MP, Gray WK, Subramanian P, Chin A-V. Cognitive assessment tools in Asia: a systematic review. International psychogeriatrics. 2016;28(2):189.
13. Van NB, Hoang LV, Van TB, et al. Prevalence and risk factors of hypertension in the Vietnamese elderly. High Blood Pressure & Cardiovascular Prevention. 2019;26(3):239-246.
14. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC geriatrics. 2014;14(1):1-14.
15. Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur heart J. 2018;39(33):3021-3104.
16. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334-1357.
17. Gangavati A, Hajjar I, Quach L, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community‐dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. Journal of the American Geriatrics Society. 2011;59(3):383-389.
18. Who EC. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England). 2004;363(9403):157.
19. Meiqari L, Essink D, Wright P, Scheele F. Prevalence of hypertension in Vietnam: a systematic review and meta-analysis. Asia Pacific Journal of Public Health. 2019;31(2):101-112.
20. Quoc Cuong T, Van Bao L, Anh Tuan N, et al. Associated factors of hypertension in women and men in vietnam: A cross-sectional study. International journal of environmental research and public health. 2019;16(23):4714.
21. Volpe M, Battistoni A, Rubattu S, Tocci G. Hypertension in the elderly: which are the blood pressure threshold values? European heart journal supplements: journal of the European Society of Cardiology. 2019;21(Suppl B):B105.
22. Islam CMZ, Meshbahur R, Tanjila A, et al. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clinical Hypertension. 2020;26(3):40-58.
23. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015-2016. 2017.
24. Mishra VK. Epidemiology of obesity and hypertension in Uzbekistan. ORC Macro; 2005.
25. Son P, Quang N, Viet N, et al. Prevalence, awareness, treatment and control of hypertension in Vietnam—results from a national survey. Journal of human hypertension. 2012;26(4):268-280.
26. Iqbal A, Ahsan KZ, Jamil K, et al. Demographic, socioeconomic, and biological correlates of hypertension in an adult population: evidence from the Bangladesh demographic and health survey 2017–18. BMC Public Health. 2021;21(1):1-14.
27. Subramanian MS, Singh V, Chatterjee P, Dwivedi SN, Dey AB. Prevalence and predictors of falls in a health‐seeking older population: An outpatient‐based study. Aging Medicine. 2020.
28. Stenhagen M, Nordell E, Elmståhl S. Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study ‘Good Ageing in Skåne’. Aging clinical and experimental research. 2013;25(1):59-67.
29. NICE CfCPa. Falls: Assessment and prevention of falls in older people. 2013.
30. Hausdorff JM, Herman T, Baltadjieva R, Gurevich T, Giladi N. Balance and gait in older adults with systemic hypertension. American Journal of Cardiology. 2003;91(5):643-645.
31. Bankoff ADP. Study on body balance in hypertensive patients. J Hypertens Open Access. 2012;1:2167-1095.1000101.
32. Kiel DP, Schmader K, Lin F. Falls in older persons: Risk factors and patient evaluation. UpToDate Waltham: UpToDate Inc. 2018.
33. Sturnieks DL, St George R, Lord SR. Balance disorders in the elderly. Neurophysiologie clinique = Clinical neurophysiology. 2008;38(6):467-478.
34. Juraschek SP, Taylor AA, Wright Jr JT, et al. Orthostatic hypotension, cardiovascular outcomes, and adverse events: results from SPRINT. Hypertension. 2020;75(3):660-667.
35. Ellmers TJ, Kal EC, Richardson JK, Young WR. Short-latency inhibition mitigates the relationship between conscious movement processing and overly cautious gait. Age and ageing. 2021;50(3):830-837.
36. Luiting S, Jansen S, Seppälä L, Daams J, van der Velde N. Effectiveness of cardiovascular evaluations and interventions on fall risk: a scoping review. The journal of nutrition, health & aging. 2019;23(4):330-337.
37. Bộ Y Tế. Dự thảo đề cương đề án chăm sóc sức khỏe người cao tuổi giai đoạn 2010-2020. Báo cáo của Bộ Y Tế Việt Nam. 2017.
38. Tran MT, Dang LT, Vu NC. Vietnamese Older Persons. Nguyen Cong Vu Mai Thi Tran Linh Thuy Dang Choy-Lye Chei. 2020:23.
2. Nguyen T-P-L, Wright EP, Nguyen T-T, et al. Cost-effectiveness analysis of screening for and managing identified hypertension for cardiovascular disease prevention in Vietnam. PloS one. 2016;11(5):e0155699.
3. Yusuf S, Joseph P, Rangarajan S, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. The Lancet. 2020;395(10226):795-808.
4. Anandita M, Mehta A, Yang E, Parapid B. Older Adults and Hypertension: Beyond the 2017 Guideline for Prevention, Detection. Evaluation, and Management of High Blood Pressure in Adults. 2020;26.
5. Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Medicine. 2017;96(4).
6. Abate M, Di Iorio A, Pini B, et al. Effects of hypertension on balance assessed by computerized posturography in the elderly. Archives of gerontology and geriatrics. 2009;49(1):113-117.
7. Ozaldemir I, Iyigun G, Malkoc M. Comparison of processing speed, balance, mobility and fear of falling between hypertensive and normotensive individuals. Brazilian journal of physical therapy. 2019.
8. Panel on Prevention of Falls in Older Persons AGS, Society BG. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society. 2011;59(1):148-157.
9. Dionyssiotis Y. Analyzing the problem of falls among older people. International journal of general medicine. 2012;5:805-813.
10. EuroSafe A. Falls among older adults in the EU-28: key facts from the available statistics. In:2015.
11. Kulkarni S, Rao R, Goodman JDH, Connolly K, O'Shaughnessy KM. Nonadherence to antihypertensive medications amongst patients with uncontrolled hypertension: A retrospective study. Medicine. 2021;100(14).
12. Rosli R, Tan MP, Gray WK, Subramanian P, Chin A-V. Cognitive assessment tools in Asia: a systematic review. International psychogeriatrics. 2016;28(2):189.
13. Van NB, Hoang LV, Van TB, et al. Prevalence and risk factors of hypertension in the Vietnamese elderly. High Blood Pressure & Cardiovascular Prevention. 2019;26(3):239-246.
14. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC geriatrics. 2014;14(1):1-14.
15. Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur heart J. 2018;39(33):3021-3104.
16. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334-1357.
17. Gangavati A, Hajjar I, Quach L, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community‐dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. Journal of the American Geriatrics Society. 2011;59(3):383-389.
18. Who EC. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England). 2004;363(9403):157.
19. Meiqari L, Essink D, Wright P, Scheele F. Prevalence of hypertension in Vietnam: a systematic review and meta-analysis. Asia Pacific Journal of Public Health. 2019;31(2):101-112.
20. Quoc Cuong T, Van Bao L, Anh Tuan N, et al. Associated factors of hypertension in women and men in vietnam: A cross-sectional study. International journal of environmental research and public health. 2019;16(23):4714.
21. Volpe M, Battistoni A, Rubattu S, Tocci G. Hypertension in the elderly: which are the blood pressure threshold values? European heart journal supplements: journal of the European Society of Cardiology. 2019;21(Suppl B):B105.
22. Islam CMZ, Meshbahur R, Tanjila A, et al. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clinical Hypertension. 2020;26(3):40-58.
23. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015-2016. 2017.
24. Mishra VK. Epidemiology of obesity and hypertension in Uzbekistan. ORC Macro; 2005.
25. Son P, Quang N, Viet N, et al. Prevalence, awareness, treatment and control of hypertension in Vietnam—results from a national survey. Journal of human hypertension. 2012;26(4):268-280.
26. Iqbal A, Ahsan KZ, Jamil K, et al. Demographic, socioeconomic, and biological correlates of hypertension in an adult population: evidence from the Bangladesh demographic and health survey 2017–18. BMC Public Health. 2021;21(1):1-14.
27. Subramanian MS, Singh V, Chatterjee P, Dwivedi SN, Dey AB. Prevalence and predictors of falls in a health‐seeking older population: An outpatient‐based study. Aging Medicine. 2020.
28. Stenhagen M, Nordell E, Elmståhl S. Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study ‘Good Ageing in Skåne’. Aging clinical and experimental research. 2013;25(1):59-67.
29. NICE CfCPa. Falls: Assessment and prevention of falls in older people. 2013.
30. Hausdorff JM, Herman T, Baltadjieva R, Gurevich T, Giladi N. Balance and gait in older adults with systemic hypertension. American Journal of Cardiology. 2003;91(5):643-645.
31. Bankoff ADP. Study on body balance in hypertensive patients. J Hypertens Open Access. 2012;1:2167-1095.1000101.
32. Kiel DP, Schmader K, Lin F. Falls in older persons: Risk factors and patient evaluation. UpToDate Waltham: UpToDate Inc. 2018.
33. Sturnieks DL, St George R, Lord SR. Balance disorders in the elderly. Neurophysiologie clinique = Clinical neurophysiology. 2008;38(6):467-478.
34. Juraschek SP, Taylor AA, Wright Jr JT, et al. Orthostatic hypotension, cardiovascular outcomes, and adverse events: results from SPRINT. Hypertension. 2020;75(3):660-667.
35. Ellmers TJ, Kal EC, Richardson JK, Young WR. Short-latency inhibition mitigates the relationship between conscious movement processing and overly cautious gait. Age and ageing. 2021;50(3):830-837.
36. Luiting S, Jansen S, Seppälä L, Daams J, van der Velde N. Effectiveness of cardiovascular evaluations and interventions on fall risk: a scoping review. The journal of nutrition, health & aging. 2019;23(4):330-337.
37. Bộ Y Tế. Dự thảo đề cương đề án chăm sóc sức khỏe người cao tuổi giai đoạn 2010-2020. Báo cáo của Bộ Y Tế Việt Nam. 2017.
38. Tran MT, Dang LT, Vu NC. Vietnamese Older Persons. Nguyen Cong Vu Mai Thi Tran Linh Thuy Dang Choy-Lye Chei. 2020:23.