Lifestyle behaviors associated with hypertension among older adults: A cross-sectional study
https://doi.org/10.52235/lp.v7i4.930
Keywords:
aged, diet, fat-restricted, hypertension, smoking, sodium, dietaryAbstract
Background: Hypertension is common in later life, while locally specific evidence on modifiable dietary and smoking behaviors among older adults in primary-care settings remains limited. Identifying lifestyle factors associated with hypertension can support targeted assessment and counseling in community and gerontological nursing.
Objective: To examine the associations of fatty-diet adherence, high-sodium-diet adherence, and smoking habits with hypertension status among older adults in the working area of Puskesmas Sungai Durian, Sawahlunto.
Methods: An analytic cross-sectional study was conducted at Puskesmas Sungai Durian, Sawahlunto, from August to September 2025. A total of 308 older adults were purposively selected from a source population of 1,345. Dietary behaviors were assessed using a 24-item hypertension diet-adherence questionnaire based on DASH principles, smoking was assessed using a five-item questionnaire, and blood pressure was measured twice at a five-minute interval. Associations were examined using chi-square tests and binary logistic regression with the three lifestyle variables entered simultaneously.
Results: Hypertension was recorded in 162 of 308 participants (52.6%). Fatty-diet nonadherence (p < 0.001), high-sodium-diet nonadherence (p = 0.011), and smoking habits (p = 0.031) were associated with hypertension in bivariate analyses. In the multivariable model, fatty-diet nonadherence was associated with higher odds of hypertension (OR = 2.675; 95% CI 1.614–4.432; p < 0.001), and the smoking term remained statistically significant (OR = 1.665; 95% CI 1.120–2.475; p = 0.012). High-sodium-diet nonadherence was not statistically significant after mutual adjustment (OR = 1.279; 95% CI 0.786–2.082; p = 0.322).
Conclusion: Among older adults in this primary-care population, fatty-diet nonadherence and smoking were associated with hypertension after mutual adjustment of the three lifestyle variables, whereas high-sodium-diet nonadherence was associated only in bivariate analysis. Because of the cross-sectional design, these findings indicate associations rather than causal effects and can inform risk assessment and lifestyle counseling in community-based care.
Downloads
References
Aburto, N. J., Ziolkovska, A., Hooper, L., Elliott, P., Cappuccio, F. P., & Meerpohl, J. J. (2013). Effect of lower sodium intake on health: Systematic review and meta-analyses. BMJ, 346, f1326. https://doi.org/10.1136/bmj.f1326
Aliasgharzadeh, S., et al. (2022). Effect of salt reduction interventions in lowering blood pressure in adults: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE, 17(12), e0277929. https://doi.org/10.1371/journal.pone.0277929
Andriani, H., et al. (2020). Effects of changes in smoking status on blood pressure among adult males and females in Indonesia: A 15-year population-based cohort study. BMJ Open, 10(4), e038021. https://doi.org/10.1136/bmjopen-2020-038021
Appel, L. J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L. P., Sacks, F. M., Bray, G. A., Vogt, T. M., Cutler, J. A., Windhauser, M. M., Lin, P. H., & Karanja, N. (1997). A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine, 336(16), 1117–1124. https://doi.org/10.1056/NEJM199704173361601
Arakawa, K., et al. (2026). Ambulatory blood pressure is higher in smokers than in nonsmokers: A systematic review and meta-analysis of observational studies. Hypertension Research. Advance online publication. https://doi.org/10.1038/s41440-026-02796-1
Ardiansyah, F., Rahayu, H., Sudarto, S., Rizkikasari, S. N., Handayani, V. W., & Lamana, A. (2022). Perbedaan Tingkat Tekanan Darah Lansia Hipertensi Antara Terapi Murrotal Al-Qur’an dan Relaksasi Otot Progresif di Wilayah Kerja Puskesmas Sungai Durian Kabupaten Kubu Raya. JKEP, 7(1), 38–53. https://doi.org/10.32668/jkep.v7i1.884
Arifin, M. H. B. M., & Weta, I. W. (2016). Faktor-faktor yang berhubungan dengan kejadian hipertensi pada kelompok lanjut usia di wilayah kerja upt puskesmas petang i kabupaten badung tahun 2016. 5(7).
BPS. (2024a). Statistik Indonesia 2024.
BPS. (2024b). Statistik Sumatera Barat 2024.
Budiono, N. D. P., & Rivai, A. (2021). Faktor-faktor yang mempengaruhi kualitas hidup lansia. Jurnal Ilmiah Kesehatan Sandi Husada, 10(2), 371–379. https://doi.org/10.35816/jiskh.v10i2.621
Efrianty, N., & Sartika, R. C. T. (2024). Hubungan tingkat pengetahuan dan sikap pada lansia dengan hipertensi dalam mengontrol tekanan darah. Lentera Perawat, 5(1), 178–184. https://doi.org/10.52235/lp.v5i1.329
Egan, B. M., Mattix-Kramer, H. J., Basile, J. N., & Sutherland, S. E. (2024). Managing hypertension in older adults. Current Hypertension Reports, 26(4), 157–167. https://doi.org/10.1007/s11906-023-01289-7
Filippini, T., Malavolti, M., Whelton, P. K., Naska, A., Orsini, N., & Vinceti, M. (2021). Blood pressure effects of sodium reduction: Dose-response meta-analysis of experimental studies. Circulation, 143(16), 1542–1567. https://doi.org/10.1161/CIRCULATIONAHA.120.050371
Filippou, C. D., et al. (2020). Dietary Approaches to Stop Hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 11(5), 1150–1160. https://doi.org/10.1093/advances/nmaa041
Gay, H. C., Rao, S. G., Vaccarino, V., & Ali, M. K. (2016). Effects of different dietary interventions on blood pressure: Systematic review and meta-analysis of randomized controlled trials. Hypertension, 67(4), 733–739. https://doi.org/10.1161/HYPERTENSIONAHA.115.06853
GBD 2017 Diet Collaborators. (2019). Health effects of dietary risks in 195 countries, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 393(10184), 1958–1972. https://doi.org/10.1016/S0140-6736(19)30041-8
Ginting, R., Hutagalung, P. G. J., Hartono, H., & Manalu, P. (2020). Faktor-faktor yang mempengaruhi pemanfaatan Program Pengelolaan Penyakit Kronis (Prolanis) pada lansia di Puskesmas Darussalam Medan. Jurnal Prima Medika Sains, 2(2), 24–31. https://doi.org/10.34012/jpms.v2i2.972
Harrison, D. G., Coffman, T. M., & Wilcox, C. S. (2021). Pathophysiology of hypertension: The mosaic theory and beyond. Circulation Research, 128(7), 847–863. https://doi.org/10.1161/CIRCRESAHA.121.318082
He, F. J., Li, J., & MacGregor, G. A. (2013). Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ, 346, f1325. https://doi.org/10.1136/bmj.f1325
Huang, L., et al. (2021). Impact of baseline potassium intake on the dose-response relation between sodium reduction and blood pressure change: Systematic review and meta-analysis of randomized trials. Journal of Human Hypertension, 35(11), 946–957. https://doi.org/10.1038/s41371-021-00510-x
Hu, K., et al. (2023). Hypertension treatment in frail older adults: A systematic review and appraisal of guidelines. Drugs & Aging, 40(10), 881–893. https://doi.org/10.1007/s40266-023-01053-1
Imelda, I., Sjaaf, F., & Puspita, T. (2020). Faktor-faktor yang berhubungan dengan kejadian hipertensi pada lansia di puskesmas air dingin lubuk minturun. Health & Medical Journal, 2(2), 68–77. https://doi.org/10.33854/heme.v2i2.532
Inayah, N., Reza, R. S., Kep, S., & Kep, M. (2022). Faktor Yang Mempengaruhi Hipertensi Pada Lansia.
Jovanovski, E., et al. (2019). Effect of high-carbohydrate or high-monounsaturated fatty acid diets on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Nutrition Reviews, 77(1), 19–31. https://doi.org/10.1093/nutrit/nuy040
Kario, K., Okura, A., Hoshide, S., & Mogi, M. (2024). The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertension Research, 47(5), 1099–1102. https://doi.org/10.1038/s41440-024-01622-w
Kartini, K., Dewi, R. S., Waluyo, D., Asriati, A., Juliana, N., Abselian, U. P., Huwriyati, J., Saptaputra, S. K., Gustin, R. K., & Saltar, L. (2022). Pengantar Epidemiologi Kesehatan Masyarakat.
Kei, A. N. (2024). Hubungan Asupan Natrium dan Lemak dengan Hipertensi di Posyandu Lansia Desa Hilir Kecamatan Serasan Kabupaten Natuna. Mutiara Multidiciplinary Scientifict Journal, 2(9), 900–914. https://doi.org/10.57185/mutiara.v2i9.253
Kementerian Kesehatan Republik Indonesia. (2024a). Survei Kesehatan Indonesia 2023 dalam angka. Badan Kebijakan Pembangunan Kesehatan, Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2024b). Laporan tematik Survei Kesehatan Indonesia 2023: Potret penyakit tidak menular di Indonesia. Badan Kebijakan Pembangunan Kesehatan, Kementerian Kesehatan Republik Indonesia.
Lai, J. S., et al. (2022). Impact of different dietary sodium reduction strategies on blood pressure: A systematic review. Hypertension Research, 45(11), 1701–1712. https://doi.org/10.1038/s41440-022-00990-5
Lichtenstein, A. H., Appel, L. J., Vadiveloo, M., Hu, F. B., Kris-Etherton, P. M., Rebholz, C. M., Sacks, F. M., Thorndike, A. N., Van Horn, L., & Wylie-Rosett, J. (2021). 2021 dietary guidance to improve cardiovascular health: A scientific statement from the American Heart Association. Circulation, 144(23), e472–e487. https://doi.org/10.1161/CIR.0000000000001031
Linda, L. (2018). The Risk Factors Of Hypertension Disease. Jurnal Kesehatan Prima, 11(2), 150. https://doi.org/10.32807/jkp.v11i2.9
Li, Y., et al. (2022). Non-pharmacological interventions for older patients with hypertension: A systematic review and meta-analysis. Geriatric Nursing, 47, 71–80. https://doi.org/10.1016/j.gerinurse.2022.06.015
Mampa, M., Wowor, R., & Rattu, A. J. M. (2022). Analisis Penerapan Pelayanan Kesehatan Lanjut Usia di Puskesmas Pineleng pada Masa Pandemi Covid-19. Jurnal Kesmas, 11(4), 7–13.
Mancia, G., Kreutz, R., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., Muiesan, M. L., Tsioufis, K., Agabiti-Rosei, E., Algharably, E. A. E., Azizi, M., Benetos, A., Borghi, C., Hitij, J. B., Cifkova, R., Coca, A., Cornelissen, V., Cruickshank, J. K., Cunha, P. G., ... Kjeldsen, S. E. (2023). 2023 ESH Guidelines for the management of arterial hypertension. Journal of Hypertension, 41(12), 1874–2071. https://doi.org/10.1097/HJH.0000000000003480
McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C., Christodorescu, R. M., Daskalopoulou, S. S., Ferro, C. J., Gerdts, E., Hanssen, H., Harris, J., Lauder, L., McManus, R. J., Molloy, G. J., Rahimi, K., Regitz-Zagrosek, V., Rossi, G. P., Sandset, E. C., ... ESC Scientific Document Group. (2024). 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal, 45(38), 3912–4018. https://doi.org/10.1093/eurheartj/ehae178
Medical record. (2025). Prevalensi Lansia. Laporan tahunan Puskesmas Sungai Durian Kota Sawahlunto.
Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J. (2016). Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation, 134(6), 441–450. https://doi.org/10.1161/circulationaha.115.018912
Miranda, s. S. R. (2019). Hubungan status gizi, pola makan (lemak, natrium, kalium) dan riwayat keluarga dengan kejadian hipertensi pada lansia di wilayah kerja puskesmas lubuk buaya padang tahun 2019. Prosiding seminar kesehatan perintis, 2(1), 1. http://repo.stikesperintis.ac.id/759/
Mulyani, S. R. (2021). Metode Penelitian. Widina Bhakti Persada Bandung.Musakkar, & Djafar, T. (2020). Promosi Kesehatan: Penyebab Terjadinya Hipertensi. Pendidikan Dan Promosi Kesehatan, 200.
NCD Risk Factor Collaboration (NCD-RisC). (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: A pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet, 398(10304), 957–980. https://doi.org/10.1016/S0140-6736(21)01330-1
Ndanuko, R. N., Tapsell, L. C., Charlton, K. E., Neale, E. P., & Batterham, M. J. (2016). Dietary patterns and blood pressure in adults: A systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 7(1), 76–89. https://doi.org/10.3945/an.115.009753
Nestel, P. J. (2019). Dietary fat and blood pressure. Current Hypertension Reports, 21(2), 17. https://doi.org/10.1007/s11906-019-0918-y
Notoatmojo, S. (2018). Metode Penelitian Kesehatan. Rineka Cipta.
Octarini, D. L., Meikawati, W., & Purwanti, I. A. (2023). Hubungan Kebiasaan Konsumsi Makanan Tinggi Natrium dan Kalium Dengan Tekanan Darah Pada Usia Lanjut. Prosiding Seminar Kesehatan Masyarakat, 1(September), 10–17. https://doi.org/10.26714/pskm.v1iSeptember.186
Purwono, J., Sari, R., Ratnasari, A., & Budianto, A. (2020). Pola konsumsi garam dengan kejadian hipertensi pada lansia. Jurnal wacana kesehatan, 5(1), 531. https://doi.org/10.52822/jwk.v5i1.120
Sacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., Obarzanek, E., Conlin, P. R., Miller, E. R., Simons-Morton, D. G., Karanja, N., & Lin, P. H. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England Journal of Medicine, 344(1), 3–10. https://doi.org/10.1056/NEJM200101043440101
Sarwoko, S. (2022). Pengaruh senam lansia terhadap tekanan darah pada pasien hipertensi Puskesmas. Lentera Perawat, 1(2), 114–120. https://doi.org/10.52235/lp.v1i2.142
Schwingshackl, L., Schwedhelm, C., Hoffmann, G., Knüppel, S., Iqbal, K., Andriolo, V., Bechthold, A., Schlesinger, S., & Boeing, H. (2017). Food groups and risk of hypertension: A systematic review and dose-response meta-analysis of prospective studies. Advances in Nutrition, 8(6), 793–803. https://doi.org/10.3945/an.117.017178
Sherwood, L. (2018). Fisiologi Manusia dari Sistem ke Sel. Human Physiology: From Cells to System, 1–870.
Song, Y., Du, K., & Jiang, H. (2026). Passive smoking and the risk of hypertension in nonsmoking adults: A systematic review and meta-analysis. PeerJ, 14, e20639. https://doi.org/10.7717/peerj.20639
Stergiou, G. S., Palatini, P., Parati, G., O’Brien, E., Januszewicz, A., Lurbe, E., Persu, A., Mancia, G., Kreutz, R., & European Society of Hypertension Council and the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. (2021). 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. Journal of Hypertension, 39(7), 1293–1302. https://doi.org/10.1097/HJH.0000000000002843
Sugiyono. (2022). Metode Penelitian. Alfabeta.
Suprapto, S., Mulat, T. C., & Lalla, N. S. N. (2021). Relationship between Smoking and Hereditary with Hypertension. Jurnal Kesehatan Masyarakat, 17(1), 37–43. https://doi.org/10.15294/kemas.v17i1.24548
Susanita, N., Anggreini, N. F. N., & Pardede, L. (2023). Hubungan Kepatuhan Diet Dengan Tekanan Darah Pada Penderita Hipertensi Di Puskesmas Perwira Bekasi Utara. Jurnal Keperawatan Abdurrab, 7(2), 23–26. https://doi.org/10.36341/jka.v7i2.4016
Syarli, S., & Arini, L. (2021). Faktor Penyebab Hipertensi Pada Lansia: Literatur Review. Ahmar Metastasis Health Journal, 1(3), 112–117. https://doi.org/10.53770/amhj.v1i3.11
Theodoridis, X., et al. (2023a). Adherence to the DASH diet and risk of hypertension: A systematic review and meta-analysis. Nutrients, 15(14), 3261. https://doi.org/10.3390/nu15143261
Theodoridis, X., et al. (2023b). Impact of the level of adherence to the DASH diet on blood pressure: A systematic review and meta-analysis. Metabolites, 13(8), 924. https://doi.org/10.3390/metabo13080924
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Journal of Hypertension, 38(6), 982–1004. https://doi.org/10.1097/HJH.0000000000002453
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
Wang, M., Du, X., Huang, W., & Xu, Y. (2022). Ultra-processed foods consumption increases the risk of hypertension in adults: A systematic review and meta-analysis. American Journal of Hypertension, 35(10), 892–901. https://doi.org/10.1093/ajh/hpac069
WHO. (2024a). World Hypertension Day 2024: Measure Your Blood Pressure Accurately, Control It, Live Longer. WHO. ho.int/srilanka/news/detail/17-05-2024-world-hypertension-day-2024--measure-your-blood-pressure-accurately--control-it--live-longer#:
WHO. (2024b, October 1). International day of older persons 2024: “Ageing with Dignity: The Importance of Strengthening Care and Support Systems for Older Persons Worldwide.” WHO. https://www.who.int/srilanka/news/detail/01-10-2024-ageing-with-dignity--the-importance-of-strengthening-care-and-support-systems-for-older-persons-worldwide
Wirawan, I. G. N. O. S., Winangun, I., Muhajir, A., & Dahlia, Y. (2023). Hubungan Pola Makan dan Tingkat Stres terhadap Hipertensi pada Lansia di Puskesmas Cakranegara Kota Mataram. MAHESA : Malahayati Health Student Journal, 3(9), 2833–2848. https://doi.org/10.33024/mahesa.v3i9.11022
World Health Organization. (2023). Global report on hypertension: The race against a silent killer. World Health Organization.
Xun, R., et al. (2023). Effects of behavioral interventions for salt reduction on blood pressure and urinary sodium excretion: A systematic review and meta-analysis. Global Heart, 18(1), 65. https://doi.org/10.5334/gh.1281
Yamato, I., et al. (2025). Impact of smoking status on incident hypertension in a Japanese occupational population. Hypertension Research, 48(1), 180–188. https://doi.org/10.1038/s41440-024-01996-x
Zaim, A. (2020). Komplikasi Hipertensi Dalam Kaitannya Dengan Pengetahuan Pasien Terhadap Hipertensidan Upaya Pencegahannya. Jurnal Penelitian Keperawatan Medik, 2(2), 2.
Zang, T., et al. (2025). Impact of fatty diets on blood pressure: A systematic review and meta-analysis. Asia Pacific Journal of Clinical Nutrition, 34(4), 542–550. https://doi.org/10.6133/apjcn.202508_34(4).0005
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Silvya Firdawati, Junios Junios, Dwi Apriadi, Fauzi Budi Satria, Erian Fatria, Asrul Fahmi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
