Advances in Health Sciences Research, volume 20

1st International Conference on Community Health (ICCH 2019)

Risk Factors of Hypertension in the Elderly

2nd Tin Utami
st Study Program D3
1 Wilis Sukmaningtyas
Study Program D3 Midwifery Faculty Of Health
Midwifery Faculty Of Health Harapan Bangsa University
Harapan Bangsa University tinutami@uhb.ac.id
wilissukmaningtyas@uhb.ac.id

1. INTRODUCTION
ABSTRACT_Hypertension is a non-
communicable disease that gets the nickname Hypertension is a "silent killer" where symptoms
"The Silent Killer", because of its can vary in each individual and is almost the same
characteristics that cause death without any as other disease symptoms. Symptoms it is a
previous symptoms. The number of elderly headache/severe sense in the nape, minerals
population in Indonesia according to 2016 (vertigo), heart palpitations, easy ielah, blurred
Susenas data is 22.4 million people or 8.69% of vision, ringing ears (tinnitus), and nose bleed [1].
the population, and hypertension is the most In general, hypertension can be defined as systolic
common disease (57.6%). Many factors can pressure more than 140 mmHg and diastolic
cause hypertension including family history, pressure more than 90 mmHg. Human blood
history of previous hypertension, and smoking. pressure naturally fluctuates throughout the day
The purpose of this study was to analyze the and will be a problem if the blood pressure is
risk factors for hypertension in the elderly in persistent [2]. Hypertension is also a major risk
Tambaksogra Village, Sumbang District, factor in the occurrence of cardiovascular disease.
Banyumas Regency. This type of research is If not handled properly, hypertension can cause
analytic descriptive research with a stroke, myocardial infarction, heart failure,
retrospective approach. The population in this dementia, renal failure, and vision disorders. The
study were all the elderly who had hypertension World Health Organization (WHO) estimates that
recorded from January to July 2019 totaling hypertension causes 9.4 million deaths and covers
217 respondents. The sampling technique used 7% of the world's disease burden [3].
is total sampling. The results of this study were The cause of hypertension can be classified into two
processed using the Chi Square test (table 2x2). namely, 1) essential hypertension (primary) occurs
The results of this study found that there was a about 95%, and direct causes are not known clearly; 2)
relationship between family history and secondary hypertension occurs around 5%, such as
hypertension history prior to hypertension in hormonal problems, large blood vessel narrowing
the elderly with p values of each p value <alpha problem or narrowing of kidney vessels [4].
(0,000 <0.05) and (0.001 <0.05), while the Hypertensive disease annually occurs, not only in
smoking habit factor found no relationship with Indonesia but also in the world.. A total of 1 in 4 adults
the value of p value> alpha (0,700> 0.05). or as many as 1 billion people suffer from hypertensive
disease. In fact, the estimated number of patients with
Keywords: family history, history of hypertension, hypertension will increase to 1.6 billion by 2025.
smoking, elderly Approximately 10-30% of adult population in almost
all countries have hypertension, and about 50-60% of
adult population can be categorized as a major majority
whose health status will be better when it can be
controlled by blood pressure [5].

Copyright © 2020 The Authors. Published by Atlantis Press SARL.

This is an open access article distributed under the CC BY-NC 4.0 license -http://creativecommons.org/licenses/by-nc/4.0/. 215
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According to the Kemenkes report year 2013, that includes the identity of the respondent, the history of
hypertension is the cause of death number 3 after hypertensive respondents, the history of hypertension
stroke and tuberculosis, where the proportion of in families, smoking habits and incidents Hypertension.
mortality reaches 6.7% of the mortality population at Data analysis is used to process data using the Chi
all ages in Indonesia. The result of basic health Square test (2x2 tables) with α = 0.05.
Research (RISKESDAS) shows the prevalence of
hypertension based on measurement results in 3. RESULT
population aged ≥ 18 years nationwide reached 25.8% 3.1. Elderly characteristics
in 2013 and increased in 2018 by 34.1% [6]. Susenas
2016 records the number of elderly people in Indonesia The results of the study, obtained that the most
as much as 22.4 million people or 8.69% of the respondents to the characteristics of the early elderly
population, and hypertension is the most suffered age of 171 respondents (78.8%), female gender as
disease (57.6%). Research conducted by Arifin about many as 137 respondents (63.1%), no previous
the factors related to the incidence of hypertension in hypertension history of 194 respondents (89.4%),
the elderly group in the working area of the afternoon There is no history of hypertension in families as much
health care I Badung Regency Year 2016, obtained as 169 respondents (77.9%), not having a habit of
results there is a meaningful relationship between smoking as many as 161 respondents (74.2%) And
genetic, Exercise and stress levels with the incidence of respondents who did not suffer from hypertension as
hypertension, while in the sex factor, obesity, smoking much as 127 respondents (58.5%) (Table 1).
and alcohol consumption there is no meaningful
relationship with the incidence of hypertension [7]. 3.2. Correlation of hypertension factors
In line with research conducted by Wahyuningsih about Respondents who did not have a history of
the factors that affect hypertension in the elderly ie age hypertension and did not suffer from hypertension as
factor, exercise habits, type of personality and obesity much as 121 respondents (55%), as well as respondents
is a factor that affects the incidence of hypertension who had a history of hypertension and suffered a
[8]. The same is done by Fitria about risk factors hypertension of 6 respondents (2.8%). Chi Square test
related to incidence of hypertension in adolescents in Results obtained p value = 0.001 < α = 0.05, it can be
the work area of inpatient Puskesmas Sidomulyo Kota interpreted there is a significant relationship between
Pekanbaru in 2012, obtained a significant relationship the previous history of hypertension and the incidence
between the history of Heredity, obesity and physical of hypertension (table 2).
activity in the event of hypertension while smoking and Respondents who had no history of hypertension in the
sodium intake does not have a meaningful relationship family and did not suffer from hypertension as much as
[9]. 112 respondents (61.6%), as well as respondents who
had a history of hypertension in the family and did not
2. MATERIALS AND METHODS suffer from hypertension as much as 15 respondents
(6.9%) Chi Square test Results obtained p value =
This type of research is a descriptive analytical 0.000 < α = 0.05, this indicates there is a significant
research with a retrospective approach, which is the link between the history of hypertension in families
research to identify the effects (illness or health status) with the incidence of hypertension (table 3).
at this time then identified risk factors that occurred In table 4, respondents did not smoke and did not suffer
time ago [10]. Research was conducted in July 2019. from hypertension as much as 93 respondents (42.9%),
The population in this study was the entire elderly who as well as the respondents who smoked and suffered a
suffered from hypertension since January – July 2019 hypertension of 22 respondents (10.1%).
in the village of Tambak Sogra of 217 respondents and Chi Square test Results obtained P value = 0.700 > α =
the entire population was made a sample. The data 0.05, this indicates there is no significant relationship
used in this research is the secondary data obtained between smoking habits and the incidence of
from the Posbindu village data of Tambak Sogra which hypertension.

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Table 4: Habit of smoking with hypertension in elderly

Table 1: Distribution of age, gender, history of
hypertension, family history of Hypertension
No No Total
hypertension and smoking in Smoking
hypertension hypertension
p value

elderly f % f % f %
No 0,700
hypertension Smoking
93 42.9 68 31.3 161 74.2
Smoking 34 15.7 22 10.1 56 25.8
Total 127 58.5 90 41.5 217 100
Characteristics Category f %
Early elderly Late 171 46 78.8
Age
elderly 21.2

Gender
Male 80 36.9
IV. DISCUSSION
Women 137 63.1
History of No Have 194 23 89,4
Hypertension 10,6 Hypertension or better known as high blood pressure
History of family No Have 169 48 77.9 disease is a condition in which a person has increased
Hypertension 22.1 blood pressure above normal resulting in an increase in
No Smoking 161 56 74.2
Smoking Smoking 25.8
pain and mortality rate (mortality). Uncontrolled
No hypertension 127 90 58.5
hypertensive disease can cause body organs to become
Hypertension Hypertension 41.5 damaged [11].
Total 217 100.0 Age is one of the important variables of the human
being because of pain and death figures almost all
Source: Secondary Data
circumstances indicate the relationship with the age
[12] and people who are 40 years old are usually
Table 2: Hypertension History relations with susceptible to increasing blood pressure can gradually
hypertension in elderly become hypertension as their age grows [2]. The
respondents of this research are at most early age.
Hypertension
History of No Total p
According to the Ministry of Health, the age of early
Hypertension
Hypertension hypertension value age was 46 – 55 years old while the late elderly 56 – 65
f % f % f %
no 121 55.8 73 33.6 194 89.4 0,001 [13].
have 6 2.8 17 7.8 23 10.6 The results of the research conducted by Dedullah at
Total 127 58.5 90 41.5 217 100
small Motoboi Sub-district of Kotamobagu south of
Kotamobagu, the incidence of hypertension is more
experienced by respondents at the age of ≥ 43 years as
Table 3: Family hypertension History relationship with much as 50 respondents (33.3%) [14]. In line with the
hypertension in elderly research carried out factors related to blood pressure,
Hypertension
research results that age ≥ 40 years have a risk of
History of No total p family hypertension hypertension at 11.71 times compared with the age of <
hypertension value 40 year [15].
Hypertension
f % f % f % In addition to age factors, gender is also one of the
no 112 51.6 57 26.3 169 77.9 0,000 factors that increase the incidence of hypertension. The
have 15 6.9 33 15.2 48 22.1
Total 127 58.5 90 41.5 217 100 respondents in this study were the most women of 137
respondents (63.1%). According to a woman's gender
manuntung more hypertension in age more than 50
years, because in that age a woman has experienced
menopause and higher levels of stress, while on the
gender of men more experienced Hypertension at the
age of less than 50 years, because in that age a man has
more activity than women [2].

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The research conducted by Arifin about the factors that can facilitate the circulation of blood so that it can
related to hypertension in the elderly group in the lower blood pressure [11].
working area of the UPT Health Center in the Badung Repeated incidence of hypertension can be termed as
district, obtained by the results that the number of relapse. Recurrence is a state of the client hypertension
elderly patients who had more hypertension in Female where the same symptoms arise as before and cause the
elderly, i.e., 49 people compared to elderly client hypertension to be treated again [18].
malegender. A total of 80 elderly women with female Hypertension can relapse, because overall hypertension
gender, among them 49 people (61.3%) who have can not be cured, but with proper management of
hypertension and 31 people (38.8%) That does not hypertension can be controlled and can reduce
suffer from hypertension [7]. recurrence. The combination of lifestyle modification
In line with Azhari research on the factors related to and antihypertensive drugs can usually keep blood
hypertension in Makrayu Puskesmas West Ilir District pressure in a range that will not damage the heart and
II, Palembang, obtained p value = 0.026 with α value = other organs [19].
0.05, p < α (H0 rejected) means indicating there is a Recurrence of hypertension occurs because of various
relationship between the The factors that trigger physical and psychological stress,
incidence of hypertension with the value of Odds improper diet (salt height), smoking habit, alcohol
ratio (OR) = 2.708, this means that respondents of consumption, and sport. It is also not much different
female gender have an opportunity of 2.7 times to be from the factors that affect the onset of hypertension
exposed to hypertensive disease compared including genetic, age, sex, ethnicity, obesity, diet
to male-gender respondents. With confidence intake pattern of high salt, smoking and personality
level (95% CI) = 1,1976,126 [16]. types [20], [21].
According to the research conducted ainiyah about
History of Hypertension with attitude relation about hypertension with recurrence
Incidence of Hypertension frequency in patients with hypertension, there is a
significant relationship between the attitude about
In table 2 respondents who do not have a history of hypertension and frequency of recurrence in sufferers
hypertension is largely experiencing hypertensive Hypertension with a value of P (0.002) is smaller than
disease by 55.8%, statistic test results obtained p = α (0.05) then Ho is rejected and Ha is accepted and the
0.001 value which means there is a meaningful magnitude value is 0467 (between 0.40-0.599)
relationship between the history of hypertension and indicating that the strength of the correlate is being
Genesis Hypertension in elderly in Tambak Sogra [22].
village.
In line with research conducted by Ratumbuysang and History of Hypertension Family with Incidence
Manado on risk factors related to incidence of of Hypertension
hypertension in pregnant women in Poly hospital
ObsGin mental hospitals Prof. Dr. V. L. Ratumbuysang In table 3, respondents who did not have a history of
City of Manado, namely there is a Relationship hypertension in the family and did not suffer from
between hypertensive history and incidence of hypertension as much as 112 respondents (61.6%). Chi
hypertension in pregnant women with value P = 0,002 Square test Result obtained a P value of 0.000 < 0.05,
(P < 0,005) [17]. this indicates there is a significant link between the
The history of hypertension experienced before can be history of hypertension in the family with the incidence
revived because of the treatment that is being of hypertension. In line with research conducted by
undergone at the time, some medicines can cause Dedullah that there is a connection between the
hypertension as in the group of drugs corticosteroids. descendants of hypertension with hypertensive events
Hypertension can also be influenced by life patterns in the community in the small Motoboi Sub District
such as excessive consumption of salt or lack of Kotamobagu south of
exercise, sports such as cycling, jogging and aerobic

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Kotamobagu city, p = 0.000 with Error rate 0.05 and area Sidomulyo Pekanbaru City Year 2012 i.e. P =
OR of 39.885 which means that the descendants of 0,000 and OR = 7.68 [9]. This is in line with the
hypertension have a risk of 39.885 times greater cause research conducted by Arifin namely there is a
of hypertensive incidence than those who do not have meaningful relationship between genetic with
the descendants of hypertension [14] hypertensive events, p = 0,019 < 0.05, Value RP
Hypertension is one of the most complex genetic 1.1417 (RP > 1) which means elderly who have a
disorders. Essential hypertension is usually associated history of hypertension in the family is Risk factors to
with genes and genetic factors, where many genes suffer from hypertension 1.417 times greater than those
contribute to the development of hypertensive who do not have a history of the family [7].
disorders. Genetic factors donate 30% to changes in
blood pressure in different populations. The role of Smoking with Incidence of Hypertension
genetic factors on the onset of hypertension is more in
monozygous twins (one egg cell) than heterozygous Table 4 shows that respondents who did not smoke and
(different egg cells). A sufferer with genetic properties did not suffer from hypertension as much as 42.9%.
of primary (essential) hypertension when left naturally Chi Square test Results obtained a P value of 0.700 >
without therapeutic intervention, with its environment 0.05, which means there is no significant link between
will cause its hyperlink to develop and in about 30-50 smoking habits and the incidence of hypertension. In
years will arise signs and symptoms [23]. line with research conducted Wahyuningsih IE there is
Suiraoka in his book says that the hereditary factor has no relationship between smoking habit with the
a very large role in the emergence of hypertension. occurrence of smoking in the elderly in Kabregan
This is evident with the discovery that more incidence Hamlet, Srimulyo, Piyungan, Bantul, Yogyakarta with
of hypertension occurs in monozygous twins compared a value of P = 0,989 > α = 0.05 [8].
to heterozygous (derived from different egg cells) [24]. In this study smoking habit is not a risk factor of
There is a history of hypertension in both parents, hypertension, it can happen because smoking is one of
enlarging the suspicion towards primary hypertension. the risk factors that can be controlled or controlled by
According to Nurkhalida in Alifariki, people with hypertension.
family history who have hypertension more often This research is in accordance with the research
suffer from hypertension and have a higher risk of conducted by Manimunda namely although the use of
hypertension 2-5 fold especially in primary tobacco is very high among the people of Nicobarese
hypertension. Data statistic proves if a person has a but it does not add to the risk of hypertension, and the
history one of his parents suffer from untransmitted majority of smoked tobacco without smoke (almost
diseases then it is possible throughout his descendants 94%), So the relationship between the use of tobacco
life has a chance of 25% infected with the disease. If without smoke and risk of hypertension has no
both parents have an uncontagious disease then the evidence [27].
likelihood of obtaining the disease is 60% [25]. Hypertension can be caused by several things, the risk
Hypertension can occur in a family, and the risk of high factors that can cause hypertension there are two of
blood pressure will increase based on age, race and factors that can be controlled and that are not
ethnicity. Genetic factors, play a role in the occurrence controllable. The controllable factor is 1) overweight or
of blood pressure, heart disease and other related obese that can cause a fat-saving so that it can affect
conditions. The risk of hypertension can increase when blood circulation; 2) Excessive consumption of salts,
there is a combination of hereditary factors and a salt is holding water so as to raise blood pressure; 3)
choice of unhealthy lifestyles, such as smoking, and Less exercise in general tends to be overweight; 4)
unhealthy food diets [26]. Stress, people who are stressed can stimulate the
Strengthening the theory that has been submitted by a adrenaline hormones that can lead to a faster heart
study conducted by Fitriana shows a significant pulsed and capillary narrowing so that blood pressure
relationship between the history of the lineage with the increases; 5) Smoking and consumption of alcohol,
incidence of hypertension in inpatient Puskesmas work nicotine contained in cigarettes can increase blood clots

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