Over half of treated older adults in Sri Lanka still have uncontrolled blood pressure - Bioengineer.org

Over half of treated older adults in Sri Lanka still have uncontrolled blood pressure

More than half of older adults in Sri Lanka who are already taking blood pressure medication still have blood pressure readings above guideline targets, according to a nationwide multicenter cross-sectional study published in BMC Geriatrics. Every participant had been on antihypertensive therapy for at least six months before recruitment, yet 52.4% had uncontrolled blood pressure, defined as a systolic reading of 140 mmHg or higher and/or a diastolic reading of 90 mmHg or higher under contemporary clinical guidelines.

The findings are striking because they come from a treated population rather than an unscreened one. Hypertension is highly prevalent among older adults and remains a major contributor to cardiovascular morbidity despite pharmacological treatment, the authors note. Age-related vascular changes, multimorbidity, and polypharmacy complicate blood pressure control in ageing populations, and factors associated with uncontrolled blood pressure in older adults, particularly in low- and middle-income countries, remain insufficiently reported.

The mean age of the cohort was 69.4 years with a standard deviation of 6.6 years, and 56.8% of participants were female. Beyond the blood pressure readings themselves, the researchers documented a heavy burden of cardiovascular disease in this population: vascular comorbidities were present in 81.6% of participants, and major adverse cardiovascular events, often abbreviated as MACE, were reported in 38.2%.

Treatment intensity emerged as another notable gap. Only 34.4% of the treated older adults were receiving dual antihypertensive therapy, meaning a combination of two blood pressure medications. Given that more than half of the cohort remained above the 140/90 mmHg threshold, the authors suggest that optimization of combination therapy is one of the care gaps that needs attention in this ageing population.

Two factors stood out. Increased neck circumference was associated with uncontrolled blood pressure, with an odds ratio of 1.009 per unit increase (95% confidence interval 1.001 to 1.018, p = 0.026). Low or moderate medication adherence was also independently associated, with an odds ratio of 1.357 (95% confidence interval 1.051 to 1.752, p = 0.019), meaning that participants with low or moderate adherence had roughly a 36% higher odds of uncontrolled blood pressure compared with those with higher adherence.

The neck circumference finding points toward sleep-disordered breathing as a possible underlying mechanism. Neck circumference is a simple anthropometric measure that can reflect tissue around the upper airway, and the authors interpret increased neck circumference as potentially reflecting sleep-disordered breathing, a condition in which repeated airway obstruction during sleep can drive sustained elevations in blood pressure. Because the association was detected in a cross-sectional analysis, the study establishes an association rather than a causal effect, but it flags a measurable and potentially modifiable characteristic that routine geriatric assessments could capture.

Equally informative were the factors that did not show a significant association with blood pressure control. Gender, socioeconomic status, physical activity, dietary salt intake, alcohol use, smoking, vascular comorbidities, and major adverse cardiovascular events were not significantly associated with BP control in the regression analysis. This pattern suggests that, in this treated older population, the dominant contributors to poor control are not the classic lifestyle exposures but rather adherence to prescribed medication and characteristics such as neck circumference that may signal sleep-related breathing problems.

The authors conclude that more than half of treated older adults in Sri Lanka have uncontrolled blood pressure despite being on treatment, and they identify suboptimal medication adherence and increased neck circumference as key contributors to poor control in this ageing population. They argue that the findings highlight important geriatric care gaps and underscore the need for adherence-focused interventions, optimization of combination therapy, and comprehensive, individualized cardiovascular risk management strategies for older adults.

The study’s design carries implications for how such data should be read. As a cross-sectional survey, it captures a snapshot of blood pressure control and associated characteristics at a single point in time across a nationally representative set of tertiary care clinics, and it cannot establish that improving adherence or reducing neck circumference would directly lower blood pressure in an individual patient. Nevertheless, the scale of the uncontrolled burden, more than half of a treated cohort, in a country-wide sample drawn from all nine provinces, provides a quantified baseline for health systems in Sri Lanka and comparable low- and middle-income settings where data on blood pressure control in older adults on treatment have been scarce.

For clinicians managing older adults with hypertension, the study offers two concrete signals to act on: assessing and supporting medication adherence, and considering neck circumference as a simple marker that may point to sleep-disordered breathing contributing to resistant readings. With 52.4% of treated older adults above target in this nationwide sample, and with only a third on dual therapy, the gap between treatment and control in this ageing population remains substantial.

Subject of Research: Prevalence and associated factors of uncontrolled blood pressure among older adults on antihypertensive treatment in Sri Lanka

Article Title: Uncontrolled blood pressure in treated older adults: gaps in control and associated factors from a nationwide multicenter study in Sri Lanka

Article References: De Zoysa, P., Weerarathna, T., Darshana, I., Egodage, U., Madhushankha, T., Jayasekara, M., Sujanitha, V., Silva, S., Matthias, A., Ratnayake, B., Mayurathan, P., Premawardana, N., & Pathirage, L. (2026). Uncontrolled blood pressure in treated older adults: gaps in control and associated factors from a nationwide multicenter study in Sri Lanka. BMC Geriatrics . https://doi.org/10.1186/s12877-026-08611-3

Keywords: hypertension, older adults, blood pressure control, Sri Lanka, medication adherence, neck circumference, sleep-disordered breathing, cross-sectional study, cardiovascular risk, antihypertensive therapy, geriatric care, BMC Geriatrics

News Source: Beatrice Stafford. (October 30, 2026). Over half of treated older adults in Sri Lanka still have uncontrolled blood pressure. Scienmag.

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