JIACM 2008; 9(4): 274-6

ORIGINAL ARTICLE

Association of Body Mass Index with Blood Pressure in the Elderly

Anil Kumar T, Sudhir U, Gita Srinivasan, Punith K

Abstract
Systolic and diastolic blood pressures have been shown to correlate with increased cardiovascular mortality and stroke in elderly
individuals. Obesity has been shown to be an independent risk factor for cardiovascular mortality and an indirect risk factor because
of its effect on hypertension, diabetes, and dyslipidaemia. The knowledge of the effect of obesity on hypertension is very important
as it is a modifiable risk factor. Studies have shown that the relation between BMI and blood pressure was stronger in females than
males. The present study was undertaken to assess the effect of BMI and gender on systolic and diastolic blood pressures in elderly
individuals.

The study was done at MS Ramaiah Medical Teaching Hospital, Bangalore. All patients who attended the geriatric camp in the
study centre and were above 65 years were included in the study. Those who had secondary risk factors for hypertension and other
confounding factors were excluded from the study. The study subjects were divided into three groups based on their body mass
index (BMI).

A total of 102 patients were included in the study. Our study showed a strong correlation between systolic blood pressures and BMI
(p < 0.02). However, the influence of sex on hypertension was statistically not significant for both systolic and diastolic blood
pressure (p > 0.05) in our study. Similar results have been obtained in various studies worldwide.

Introduction individuals.

Systolic and diastolic blood pressures have been shown
to correlate with increased cardiovascular mortality and
stroke in elderly individuals1-3. Obesity has been shown
to be an independent risk factor for cardiovascular
mortality and an indirect risk factor because of its effect
on hypertension, diabetes, and dyslipidaemia4, 5.
Not much data is available regarding the association
between obesity and hypertension in the elderly. While
studies in the United States showed a positive correlation
between body mass index (BMI) and systolic and diastolic
blood pressures in the elderly6, 7, a similar study in Japan
concluded that the effect of BMI on systolic and diastolic
blood pressures was much weaker in the elderly 8 .
Unfortunately, no studies are available in India regarding
the correlation between blood pressure and BMI. The
knowledge of the effect of obesity on hypertension is very
important as it is a modifiable risk factor. The present study
was undertaken to assess the effect of BMI on systolic and
diastolic blood pressures in elderly individuals.
Objectives
l To assess the influence of gender on hypertension in
elderly individuals.
Material and methodology
The study was done in August-September, 2007 at MS
Ramaiah Medical Teaching Hospital, Bangalore. It is a cross-
sectional study. All the subjects attending geriatric camp
for general check-up and aged above 65 years were
included in the study. Subjects who were known cases of
hypertension, diabetes, coronary heart disease, stroke,
chronic renal failure, chronic alcohol abuse, and those who
were on cholesterol lowering medications were excluded
from the study.
All the subjects attending the geriatric camp were
screened for the inclusion and exclusion criteria and
suitable subjects were considered. These individuals were
then briefed about the study and an informed consent
was taken. A total of 102 patients were included. All the
subjects were subjected to one time clinical examination
and laboratory investigations.

l To assess the correlation between body mass index The clinical examination included a detailed history
and systolic and diastolic blood pressure in elderly regarding any addictions, e.g., smoking and alcohol, and

Department of Medicine, MS Ramaiah Medical Teaching Hospital,

MSRIT Post, New BEL Road, Bangalore - 560 054, Karnataka.
it was then followed by a thorough systemic examination. II and III (p < 0.02).
Height and weight were recorded and the BMI was
calculated. BMI (or Quetelets index) was defined as weight 190

Systolic blood pressure (mmHg)

182
in kilograms divided by height in meter squared.This index 180
170
has been shown to be a good measure of obesity and is 158.4
160
159.2
applicable to all populations. 150
147.1
140
Blood pressure was recorded in the sitting position three 130 135.8
times on the left arm with a standard sphygmomanometer 120 129
and Velcro cuff, and the average of three readings was 110
100
used in the analysis. The systolic and diastolic blood I II III
pressures were taken as the point of appearance and Systolic blood pressure in males and
disappearance of Korotkoff sounds respectively. females among the three groups
The subjects were asked to come the following day in a Male Female
fasting state for laboratory investigations. Fasting lipid Graph 1: Mean systolic blood pressure in various groups of study
profiles, fasting blood sugar, and serum creatinine levels subjects.
were done.
Diastolic blood pressure (mmHg) 94 90.8
92 91.2
Statistical analysis
90
The patients were divided into three groups based on their 88 88.6
86
BMI (group I - 15 - 19.9 kg/m2, group II - 20 - 24.9 kg/m2, 84
group III - 25 - 30 kg/m2). The mean systolic and diastolic 82 84
82.6
blood pressure for both the male and female categories 80
78 79.8
of patients was compared in the three categories of 76
patients with students t-test .The mean blood pressure 74
I II III
recordings between both the genders was also analysed
Diastolic blood pressure in males and
using students t-test The software used for statistical females among the three groups
analysis was SPSS version 11.
Male Female
Results Graph 2: Mean diastolic blood pressure in various groups of study
subjects.
Table I: Demographic profile of the study subjects.
Group Mean No. of Male Female The increase in diastolic blood pressure was not
BMI (kg/m2) patients statistically significant between the groups (p > 0.05).
I 18.5 34 20 14
Discussion
II 22.47 36 22 14
III 27.63 32 20 12 The Honolulu Heart Programme cohort analysing old
Japanese men revealed the close relationship between
The table describes the gender distribution and mean BMI basal BMI and systolic and diastolic blood pressures9.
in various groups. Similar results have been obtained by Huang et al10 in
China and by Amador et al11 in Mexico. In industrialised
The systolic blood pressures were found to increase
nations, systolic blood pressure rises continually with age,
progressively with the increase in BMI in both groups of
whereas diastolic blood pressure rises until middle-age
patients (male and female). There was a statistically
and then tends to level-off12, 13.
significant increase in the systolic blood pressure
between group I and II (p < 0.0001), and between group Our study showed a strong correlation between systolic

Journal, Indian Academy of Clinical Medicine l Vol. 9, No. 4 l October-December, 2008 275
blood pressures and BMI. To minimise the influence of
the various factors, we selected a fairly homogeneous
group of patients by excluding alcoholics, known
hypertensives on treatment, diabetics; and secondary
causes of hypertension like chronic renal failure, cancer,
and coronary heart disease. The diet was fairly uniform
as most of them were south Indians from a highly localised
area.
The Tromsa study done by Wilsgaard et al showed the
relation between BMI and blood pressure was stronger in
females than males14. However, in our study, the influence
of sex on hypertension was statistically not significant for
both systolic and diastolic blood pressure (p > 0.05).
Hypertension is one of the most common chronic
conditions seen in the elderly population. If control of
obesity in the elderly helps in reduction of blood pressure,
emphasis on active lifestyle and a healthy diet are cost-
effective measures in improving the quality of life in the
elderly. The data obtained from our study for the
association of BMI and blood pressure is limited. Further
studies in a larger scale are warranted to establish the
correlation between the two.
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A N N O U N C E M E N T
MRCP EXAMINATION IN INDIA
Recognised by Indian Medical Council (M.C.I.)
Applications are invited from the prospective
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Examinations:
MRCP Part I : 12th May 2009
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MRCP Part II Clinical : December 2009
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l Vol. 9, No. 4 l October-December, 2008