http://doi.org/10.33698/NRF0058  Jasbir Kaur

Abstract : This cross-sectional study was conducted from Jan 2001 to March 2002 on 500 rural and 500 urban Jat Sikh women, ranging in age from 36 to 81 + years. Number of subjects with literacy, job and widow or divorced were more found among urban area as compared to rural subjects. Systolic and diastolic blood pressure have shown a trend of increase upto 8th decade in both urban and rural Jat Sikh women. The systolic blood pressure as well as diastolic blood pressure have been found to be higher in urban than rural Jat Sikh women at all age groups with significant differences at age groups 46-50, 66-70, 71-75 and 81+ years.

The systolic blood pressure has shown correlation with age, weight, and naval to hip circumference ratio and stressful life events of whole life in both urban and rural Jat Sikh women. Naval circumference has shown strong correlation with systolic and diastolic blood pressure in both groups. The systolic blood pressure has been correlated with naval to hip ratio. The body mass index and total body fat were correlated with systolic and diastolic blood pressure in rural Jat Sikh women only. There was strong correlation with biophysical factors whereas stress events had comparative week positive correlation with blood pressure.

Key words :

Blood pressure, urban, rural, jat sikh women.

Correspondence at : Jasbir Kaur

College of Nursing DMCH, Ludhiana.

Introduction  The ageing process is called “Senescence” (Latin). Senescence means to grow old and it is characterized by gradual decline in the functioning of all systems (Rose, 1984). The old age and diseases go hand in hand. Among different diseases, which commonly affect elderly are arthritis, heart disease, hypertension, diabetes, asthma and skin diseases. High blood pressure is the most important point of concern in this population since it is the main cause of many other health derogating illness like stroke, coronary artery disease, renal complications etc. In nut shall one can say it is silent killer disease.

Blood pressure rises steadily during the years from bir th to adulthood in all populations. Blood pressure usually increase with age reported by many investigators in cross-sectional studies (Mcgarvey & Baker 1979 and Keil et al., 1980). It has been found that prevalence of hypertension is significantly higher in urban population (Koyama et al., 1988). Traditional societies have little or no increase in adult blood pressure (Day et al., 1979). Halberstein (1983) in his study of urban population of West Jawa found that climate, degree of urbanization, work schedules, activity pattern and dietary behaviours affect the levels of blood pressure. The continuous increase of blood pressure during adulthood is a major public health concern in modern populations because of its high correlation with cardio-vascular disease.

During the last few decades the role and status of women have changed. The urban women being more educated are joining out of home employment. The dual strain of working at home and full time job may cause adverse effect on their health but at the same time financial independence might have changed their mental and physical outlook along with change in their socio-economic status. The rural women on the other hand are doing much more physical work from morning till late in the evening but their work is invisible and some time goes unrecorded and unrewarded. The economic backwardness along with illiteracy has caused serious problems in rural women. Therefore, the life style of Jat Sikh women residing in rural areas is totally different from Jat Sikh women residing in urban areas. Blood pressure seems to be immediately affected by the changes in environment and life style as reported by many investigators Singal et al. (1999) repor ted in Jat Sikh females of Bathinda district of Punjab that blood pressure is more in urban than rural females at most of age groups. Sethi et al. (1996) found strong correlation of systolic blood pressure with age in both working and non-working Khatri females of Punjab and found positive co- relation with weight, percentage fat and abdominal circumference.

The present study has been under taken to find how life style affects the blood pressure with ageing in rural and urban Jat Sikh women from 36 to 81+ years with the following objectives in view.

Objectives

  1. To find out and compare the blood pressure changes with age among elderly urban & rural jat sikh
  2. To determine correlation of Systolic and Diastolic Blood Pressure with selected biophysical & psychosocial

Materials and Methods

This cross-sectional study was conducted from Jan 2001 to March 2002 on 500 rural and 500 urban Jat Sikh women, ranging in age from 36 to 81 + years. Using simple random sampling drew rural and urban women, rural setting included total 18 villages, those were Dhahan Kaleran, Bika, Kangror, Kajala, Jhikka, Sujjon, Bhaura, Naura, Khamacho, Thandian, Sarhal Kazian, Chak Ramu, Chak Bilgan, Baharo Mazra, Kattan, Rasulpur, Langeri and Mehli. Urban sample has been drawn form Chandigarh, Phagwara, Ludhiana, Jalandhar and Patiala.

The study is based on fif teen anthropometric measurements including weight, linear dimensions, circumferences, diameters and skinfolds. The measurements have been taken on each subject by following Standard techniques as given by Tanner et al.(1969). The physique and body compositions have been derived from these measurements. The somatotypes have been studied by applying Heath and Carter method (1967). The body composition has been studied by applying various equations given by Durnin and Womersley (1974). The blood pressure and age at menopause have also been recorded. The systolic and diastolic blood pressure has been measured by using mercury sphygmomanometer. Pulse rate has been recorded from the beats of radial artery. The psychosocial stresses have been measured by applying Presumptive Stressful

Life Events (P.S.L.E.) scale developed by Singh et al. (1983). Referring above all mentioned authors final tools were developed and they were valid and reliable. Collected data were analyzed and presented by using descriptive and inferential statistics.

Results

In present study 500 urban and 500 rural women were studied between the age group of 35 to 81+ years. These women were divided in 10 age group categories with 5 years interval and fifty women were studied in each categories in each urban and rural group.

Table 1 depicts that, urban Jat Sikh women consisted of 74.8% married, 23.8% widows and 1% divorced women, while among rural group 77.6% are married, 22.6% are widows and 0.4% are divorced. About fifty per cent urban Jat Sikh women were illiterate rest of them were primary (13.8%) Matric (21.), graduate (13.4%), and post graduation & above (8.6%). While in rural group 64.8% were illiterate, 34.4% had school education, 0.6% were graduated and only 0.2% were post graduation. As per educational status in urban areas, only 19% women are employed, 77% women were housewives and 4% were retired. In rural area, 98.8% women were housewives and only 0.2% women are retired and none was employed. In urban group 35% women verbalized service as a source of income of the family, rest of them mentioned business (14.8%), agriculture (26%), pensioners (24%) as their source of family income. However, in rural areas majority of subjects i.e. 92% had agriculture as their source of family income rest of them had other sources of income.

 

Table 1: Socio-demographic profile of subjects N = 1000
Characteristics                                          Urban (n=500) Rural (n = 500)
f      (%) f    (%)
Marital status  
Married                                   374 (74.8) 388 (77.6)
Unmarried                                   02 (00.4) —-    ——
Widow                                    119 (23.8) 110 (22.0)
Divorced                                      05 (01.0) 02 (00.4)
 

lliterate

 

213 (42.6)

 

324

 

(64.8)

Primary 69 (13.8) 115 (23.0)
Matric 108 (21.6) 57 (11.4)
Graduate 67 (13.4) 03 (00.6)
P.G 38 (07.6) 01 (00.2)
Ph.D. 05 (01.0) —- —–

 

Educational Status

Occupational status

Service                                     95 (19.0)                                   —- —–

 

Housewife 385 (77.0) 499 (99.8)
Retired 20 (04.0) 01 (00.2)
Source of family Income        
Service 175 (35.0) 16 (3.20)
Business 74 (14.8) 09 (1.80)
Agriculture 130 (26.00 460 (92.0)
Pension 121 (24.2) 14 (2.8)

The Figure 1 presents the systolic blood pressure of urban and rural Jat Sikh women from age 36 to 81 years. In Urban Jat Sikh women the systolic blood pressure has shown gradual increase from 119.60 mm of Hg at age group 36-40 to a peak level of 155.04 mm of Hg at age 71-75 followed by decrease in the subsequent age groups reaching a level of 137.08 mm of Hg of age 81+ years.

In rural Jat Sikh women, systolic blood pressure has increased from 119.24 mm of Hg at age group 36-40 to 128.72 mm of Hg at 51-55 years and remained more or less stable after 56 years till 70 years followed by increase to 136.08mm of Hg at age group 71- 75years. After this, there has been observed a gradual decrease to 127.60mm of Hg at 81+years.

 

 

 

Figure 1: Systolic blood pressure with age groups

 

 

 

Figure 2 shows diastolic blood pressure in urban and rural Jat Sikh women from 36 years to 81+ years. In urban Jat Sikh women, diastolic blood pressure increased from 76.52 mm of Hg at age group 36-40 to 89.96 mm of Hg at the age group 71-75 years. After this,

 

there is a trend of decrease 83.16-mm of Hg at 81+years.

In rural Jat Sikh women, the diastolic blood pressure increased from 72.40 mm of Hg at age group 36-40 to 80.04 at age group of 76-80. After this, it has decreased 76.88 at 81+ years.

 

 

 

 

 

 

 

 

BLOOD PRESSURE (DIASTOLIC)

Table 2 presents the values of correlation coefficients of systolic and diastolic blood pressure with age, weight, arm circumference, naval circumference, hip circumference, naval hip circumference ratio, BMI, total body fat, fat free mass and stress score and stressful life events of whole life. All the values of ‘r’ above 0.10 have been found to be significantly different from zero.

The systolic blood pressure has shown correlation with age, weight, and naval to hip circumference ratio and stressful life events of whole life in both urban and rural Jat Sikh women.

Out of circumferences, the naval circumference has shown more correlation

with systolic and diastolic blood pressure in both urban and rural Jat Sikh women except upper arm circumference, which has shown more correlation with diastolic blood pressure in rural women only whereas. The systolic blood pressure has been correlated with naval to hip ratio. The body mass index and total body fat are correlated with systolic and diastolic blood pressure in rural Jat Sikh women only. The blood pressure has more correlation with stress score of whole life in urban as compared to rural women whereas only diastolic blood pressure it has been correlated with stress score of one year in rural women.

Table 2 : Correlation coefficients of different variables with Systolic and Diastolic Blood Pressure in urban and rural Jat Sikh Women

 

Variables Systolic Blood Pressure Diastolic Blood Pressure
Urban Rural Urban Rural
Age 0.30* 0.17* 0.20* 0.10*
Weight 0.10* 0.12* 0.11* 0.17*
Upper Arm Circumference 0.003 0.131* -0.015 0.158*
Naval Circumference 0.134* 0.131* 0.102* 0.142*
Hip Circumference 0.033 0.106* 0.055 0.138*
Naval Hip Circumference ratio 0.178* 0.105* 0.087 0.074
Body Mass Index 0.042 0.144* 0.019 0.161*
Total Body Fat -0.005 0.109* -0.032 0.155*
Free Fat Mass 0.032 0.091* -0.014 0.130*
Blood Pressure Systolic 0.672** 0.800*
Blood Pressure Diastolic 0.672* 0.800*
Endomorphic Component -0.142* 0.050 -0.112* 0.091*
Mesomorphic Component 0.042 0.153* 0.065 0.140*
Ectomorphic Component 0.024 -0.154* 0.056 -0.152*
Stress score 1 year .093* 0.074 0.060 0.116*
Stress score of whole life 0.144* 0.067 0.141* 0.063
Stress full life Events of 1 year 0.101* 0.039 0.085 0.084
Stress full life Events of whole life 0.155* 0.073 0.139* 0.079

Discussion The number of widow and divorced women are more in urban than in rural Jat Sikh Women. Illiteracy has been found to be more in rural than urban Jat Sikh Women. It shows that more women are doing jobs in urban and majority of the rural as well as urban Jat Sikh women are housewives.Blood pressure has been reported to be rising steadily during the years from birth to adulthood in all populations. Blood pressure usually increase with age as has been repor ted by many investigators (Mcgarvey and Baker 1979; Keil et al., 1980 and Koyama et al., 1988). In the present study, systolic blood pressure has been noticed to increase steadily from 119.60 mm of Hg at the age group 36-40 to 155.04 mm of Hg at age group of 71-75, thus there has been increase of 35.44 mm of Hg in 35 years in urban Jat Sikh women. After 71-75 years, it shows a decrease to 137.08 mm of Hg at age group 81+, while in rural setting blood pressure rises from 119.24 at age group 36.40 to 136.08 mm of Hg at age group 71-75 and then there has been a sharp fall to 127.60 mm of Hg at age group 81+ years (Figure 1). The blood pressure was higher in urban than rural Jat Sikh women at all the age groups, however the significant differences are found in age groups are 46-50, 66-70, 71-75 and 81+years.

Diastolic pressure also has been increased with age in two samples. In urban Jat Sikh women it has been increased from 76.50 mm of Hg at age group 36-40 to 89.96 mm of Hg at age group 71-75 years, then fell to 83.16 mm of Hg at 81+ years. In rural Jat Sikh women diastolic blood pressure has been increased from 72.40 mm of Hg at age group 36-40 to 80.04 mm of Hg at age group 76-80 and then fell to 76.88 mm of Hg at age group 81+ (Figure 2). Like systolic blood pressure the diastolic blood pressure has been found to be higher in urban all ages with significant differences at age groups 46-50, 61-65, 66-70, 71-75 and 81+ years.Traditional societies have little or no increase in adult blood pressure. Traditional population with low levels of blood pressure which do not increase with age, may have the benefit of a genetic protection, a traditional culture may be lacking physical or psychological pressures (Keil et al., 1980). Some traditional groups who migrated to westernized areas or undergo modernization have shown tendencies towards increased blood pressure with ageing (Mcgarvey, 1979).

Koyama et al. (1988) also reported higher levels of blood pressure in urban population in West Jawa. Various factors like climate, degree of urbanization, work schedule, activity pattern and dietary behaviour affect the levels of blood pressure. In the present study also slightly more values of blood pressure in urban Jat Sikh women may be attributed to differences in work schedule, activity pattern and dietary behaviours of the two groups.

Rao, (1980) reported increase of blood pressure from age group 15-25 to 67-75 in females of semi-urban area of Andhra Pradesh. Mukherjee et al.(1988) reported in fishing community of West Bengal, an increase in systolic blood pressure with age. Singal et al. (1999) also reported in Jat Sikh females of Bathinda district of Punjab that blood pressure has been more in urban than rural females at most of the age groups.

In the present study also, urban Jat Sikh women have more blood pressure, as they are heavier than rural Jat Sikh women. Association of weight and body mass index with blood pressure has been reported by many authors (Boyce et al., 1978; Koyama et al., 1988; Sethi et al., 1996, Gerber and Stern 1999; Ferraro and Both, 1999; Singal et al., 1999). The relationship of body mass to blood pressure and Cardio-vascular diseases has been recognized for many years. Body size exerts a profound influence on a variety of physiological functions, like blood pressure. Gerber and Stern (1999) reported a strong linear relationship between weight, height and blood pressure. This relationship has been attributed to both genetic and environmental factors. Ferraro and Booth (1999) reported the relationship of BMI to functional illness and association of obesity with greater risk of diseases like hypertension, diabetes mellitus, cardio-vascular diseases and osteo-arthritis. The risk of morbidity and mortality are higher for obese persons.

Due to rapid industrialization and associated stress and strains, the incidence of hypertension is on the increase in all the population. Diet and environment are the two main factors, which lead to high blood pressure as reported by Sharma (1993). In a survey to find the incidence of hypertension among professionals and industrial workers of Ludhiana, the findings show that 14% of the professional and 2.7% of industrial workers were hypertensives. No single factor can be make responsible for higher blood pressure but it is an interplay of several factors like family history, obesity, smoking, moderate to heavy alcohol intake, high salt intake, diabetes and of course the ill-defined phenomenon of stress and strain.The atmospheric temperature was also found to affect blood pressure of older people. Sharma (1993) has observed that blood pressure is higher in winters as compared to summers.

Sethi et al. (1996) also reported strong correlation of systolic blood pressure with age in both working and non-working Khatri females of Punjab and found positive co- relation with weight, percentage fat and abdominal circumference.

Dressler (1999) studied the relationship between stress and blood pressure and reported that increase in blood pressure in more modernized communities is due to the stressful nature of cultural and social changes. In the present study also, there has been a positive correlation between stress and blood pressure.

Renganath (2002) also reported more hypertension in urban area as compared to rural India. The hypertension rate has been reported to be higher in the females and the prevalence rate among the elderly was 20 times more than general population. Gerber et al., 1989 have also repor ted high correlation of abdomen to hip ratio with systolic and diastolic blood pressure.

Conclusion

Number of subjects with literacy, job and widow or divorced were more found among urban area as compared to rural subjects. Systolic and diastolic blood pressure have shown a trend of increase upto 8th decade in both urban and rural Jat Sikh women. The systolic blood pressure as well as diastolic blood pressure have been found to be higher in urban than rural Jat Sikh women at all age groups with significant differences at age groups 46-50, 66-70, 71-75 and 81+ years.

The systolic blood pressure has shown correlation with age, weight, and naval to hip circumference ratio and stressful life events of whole life in both urban and rural Jat Sikh women. Naval circumference has shown strong correlation with systolic and diastolic blood pressure in both groups. The systolic blood pressure has been correlated with naval to hip ratio. The body mass index and total body fat were correlated with systolic and diastolic blood pressure in rural Jat Sikh women only. There was strong correlation with biophysical factors whereas stress events had comparative week positive correlation with blood pressure.

References

  1. Boyce, J., Attenborough, R.D. and Harrison, G.A. (1978): Variation in blood pressure in New Guinea populat
  2. Dressler, W. (1999): Modernization, stress and Blood Pressure: New Directions in research. Human biology, 71: 583 – 605.
  3. Gerber M. and Stern P.M. (1999): Relationship of body size and body mass to blood pressure: Sex-specific and developmental influences. Human Biology, 71: 505 – 528.
  1. Halberstein, A. (1983) : Biological aspects of high blood pressure in Bahamas. Am.
  2. Phy. Anthrop. Annual Meeting Issue, 60:203.
  3. Indrayan, A; Srivastava N. and Bagchi,

S.C. (1972): Age regression of blood pressure in an urban population of age 15-59 years. Ind. J. Med.Res.,60:966-972.

  1. Koyama, , Moji K. and Suzuki S. (1988): Blood pressure, urinary sodium/potassium ratio and body mass index in rural and urban populations in West Java. Hum. Biol., 60:263- 272.
  2. McGarvey, T. (1984): Prospective role of subcutaneous fat distribution of blood pressure in modernizing Samoan women. Am. J. Phys. Anthrop., Annual meeting issue, 12:127-128.
  3. McGarvey, T. and Baker P.T. (1979): The effects of Modernization and Migration on Samoan blood pressures, Human Biol.,51: 461-479.
  4. Mukherjee, B.N., Byard, J., Bhattacharya, S.K. and Rao, D.C. (1988): Blood pressure in rural West Bengal fishing community: An epidemiologic profile. Hum. Biol., 60: 69-79.
  5. Rao R. (1983): Blood pressure and triceps skinfold thickness. Annals of Hum. Biol., 10: 191-193.
  6. Rao, S. (1980): Blood Pressure in relation to age and sex in semi urban population. Ann.Hum. Biol., 7:277-280.
  7. Singal, , Sethi, H.K. and Sharma, M. (1999): Changes in blood pressure and some related variables with ageing in rural and urban Jat Sikh females. Human growth – A multidisciplinary approach, 87-94.

Troisi, R.J.K., Weiss, S.T. and Segal, M.R. (1990): The relationship of body fat distribution to blood pressure in normontensive men. Int. J. Ob