Mahesh Chavhan* 2
Girish Chavhan 1
Hypertension (HTN) remains one of the leading modifiable contributors to cardiovascular disease, especially among the elderly. Its burden increases with age due to physiological changes and exposure to lifestyle risks such as physical inactivity, unhealthy diet, obesity, tobacco and alcohol use, and poor stress control. India is witnessing a rapid rise in its geriatric population, reaching nearly 138 million individuals aged 60 years and above in 2021. Despite this demographic growth, hypertension control remains inadequate. According to the World Health Organization, one in four Indian adults is hypertensive, and only 12% achieve optimal blood pressure control8. National estimates from NFHS-5 further indicate substantial levels of undiagnosed, untreated, and uncontrolled hypertension across the country19. This highlights a significant gap in effective management and follow-up care for older adults. Medication use patterns19, such as adherence, polypharmacy, type of antihypertensive drugs used, affordability, accessibility and follow-up practices play an important role in achieving adequate control but are often overlooked in routine assessment. In this context, a mixed-method study becomes essential to understand not only the prevalence and determinants of HTN but also the lived experiences and treatment-related challenges faced by the geriatric population in Eastern Maharashtra, enabling more patient-centred and practical care strategies.
AIM & OBJECTIVES:
- To estimate the prevalence of hypertension among the geriatric population of Eastern Maharashtra.
- To identify socio-demographic determinants and medication use patterns related to hypertension, including adherence, polypharmacy, type of drugs used, affordability, accessibility, and follow-up practices.
- To explore the lived experiences, perceptions, and challenges faced by geriatric in managing hypertension.
MATERIALS AND METHODS:
The present Explanatory Mixed Method study was conducted at a tertiary health care centre in Eastern Maharashtra from January 2025 to February 2026. All individual of ≥60 years of age willing to participate were enrolled for the study and those who were seriously ill or with psychological illness were excluded.
Sample size: Considering the prevalence of HTN in geriatric population to be 60% as per the previous study conducted in 20233, the estimated sample size was calculated to be 370 using the Cochren’s formula with absolute precision of 5% and at 95% CI.
Sampling technique: A simple random sampling was used for selection of participants for quantitative data. All individual of ≥60 years of age were interviewed using the face-to-face interview and for the qualitative data in depth interview was taken.
Data collection tool: A predesigned, pretested proforma in a vernacular language (Hindi or Marathi) was used for quantitative data. The proforma consisted of two sections (Part A & B). Questions seeking information on participants' sociodemographic characteristics, such as age, gender, residence, religion, marital status, education, occupation, type of family and socioeconomic status constituted part A. Socioeconomic status was assessed by using Modified BG Prasad scale, 202518,11. Part B comprised questions dealing with Medication use Patterns such as adherence to medications, number of drugs taken, type of drugs, affordability, accessibility and follow- up were asked and Lived Experiences of Hypertension were recorded.
BP measurement: Three readings after 3 minutes rest were taken and lowest of these were used13. Hypertension defined by current standard guideline used in JNC 8 cutoffs13 For the qualitative data, in depth interview was of those willing to talk freely were conducted till the point of saturation achieved39,40. This study obtained clearance from the Institutional Ethics Committee. Informed consent of participants was taken and confidentiality was maintained throughout the study.
Operational Definitions:
Hypertension: Defined as a mean systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or a self-reported history of a physician diagnosis and currently taking anti-hypertensive medication13.
Controlled BP: Defined as BP <140/90 mmHg among those diagnosed with HTN. The threshold of <140/90 mmHg was used based on general guidelines for the elderly population without high-risk co-morbidities.
Obesity: Defined using Body Mass Index (BMI) ≥25.0 kg/m2 for the Asian Indian population.
Sedentary Lifestyle: Self-reported lack of at least 150 minutes of moderate-intensity physical activity per week
Lived experiences: Personal perceptions, beliefs, and challenges expressed by elderly individuals related to hypertension management.
Medication adherence: It is considered as “Poor” if tablets were consumed is <95% of schedule in a month and “Good” if it was ≥95%.
Polypharmacy: Use of ≥3 medications for a single condition3.
Statistical Analysis:
Data was entered in MS Excel window version 11 and analysed by using Open-Epi Software. Descriptive statistics, quantitative variables were measured as Mean, Standard Deviation, Range. Bar chart & pie chart were used to summarise baseline characteristics of the study participants. Association between two categorical variables were analysed by using Chi-square (X2) test; p value < 0.05 was considered to be statistically significant, Odds Ratio was calculated. Manual content analysis was done.
Themes in Qualitative Analysis:
Theme 1: Limited Disease Insight
Theme 2: Fear of Long-term Medication
Theme 3: Physical Barriers to Lifestyle Modification
Theme 4: Financial Constraints
Theme 5: Insufficient Family Support
RESULTS:
A total of 370 geriatric participants were enrolled in this study, Among them predominantly were in 60- 65 years age group 177 (47.84%) and were males 212(57.30%). Majority were Hindus 210 (56.76%), married 269 (72.70%), residing in nuclear families 183 (49.46%), and nearly half had education ≥ high school 186 (50.26%). More than half were non-earners 204 (55.14%) and most belonged to middle to lower socio-economic strata 252 (68.10%) as per the Modified BG Prasad Classification 2025.
Table 1: Sociodemographic characteristics of the study participants (n= 370)
|
Variables |
No |
% |
|
|
Age (completed years) |
60- 65 |
177 |
47.84 |
|
65- 70 |
102 |
27.57 |
|
|
70-75 |
62 |
16.76 |
|
|
≥ 75 |
29 |
07.83 |
|
|
Gender |
Male |
212 |
57.30 |
|
Female |
158 |
42.70 |
|
|
Religion |
Hindu |
210 |
56.76 |
|
Muslim |
101 |
27.30 |
|
|
Sikh |
54 |
14.59 |
|
|
Others |
05 |
01.35 |
|
|
Marital status |
Married |
269 |
72.70 |
|
Single* |
65 |
17.57 |
|
|
Type of family |
Nuclear |
183 |
49.46 |
|
Joint |
138 |
37.30 |
|
|
Three generation |
49 |
10.54 |
|
|
Educational status |
Illiterate |
57 |
15.41 |
|
Primary |
46 |
12.43 |
|
|
Middle School |
81 |
21.90 |
|
|
≥ High school |
186 |
50.26 |
|
|
Earning Status |
Earner** |
166 |
44.86 |
|
Non- earner |
204 |
55.14 |
|
|
Socio‑economic class (Modified BG Prasad scale, 2024) |
Class I |
56 |
15.14 |
|
Class II |
62 |
16.76 |
|
|
Class III |
90 |
24.32 |
|
|
Class IV |
83 |
22.43 |
|
|
Class V |
79 |
21.35 |
|
*Single: separated, divorced, widowed, widower
**Earner: Working + Pension
The prevalence of hypertension among geriatric participants was 61.90% (229/370). Among females and males 70.25% and 57.30% were hypertensive. These findings indicate a substantial burden of hypertension with a notable female predominance in the geriatric age group. (Fig 1 & 2)
10.5281/zenodo.19413852