Asian Pac. J. Health Sci.

, 2015; 2(3):66-71 e-ISSN: 2349-0659, p-ISSN: 2350-0964

____________________________________________________________________________________________________________________________________________

Blood Pressure values of Sri Lankan Tamils in Jaffna District, Sri Lanka
Balasubramaniam M*, Sivapalan K, Tharsha J, Sivatharushan V, Nishanthi V, Kinthusa S, Dilani
M
Department of Physiology, Faculty of Medicine, University of Jaffna, Sri Lanka

ABSTRACT
Objective: To measure the blood pressure values of healthy Sri Lankan Tamils in Jaffna district and to correlate
with anthropometric characters. Design and setting: Descriptive cross sectional study among the healthy Sri Lankan
Tamils living in Jaffna district. Measurements: An interviewer administered questionnaire was used to select non
smoking non alcoholic healthy volunteers. Age, Height, weight, Waist Circumference (WC) and Hip Circumference
(HC) were obtained. Waist Hip Ratio (WHR) and Body Mass Index (BMI) were calculated. Blood pressure values
were measured with mercury sphygmomanometer. Lowest blood pressure out of three readings obtained in 5
minutes interval after adequate rest was used for analysis. Results: Total of 1529 (615 males & 914 females)
participants were included in this study. The age range of participants was 15-92 years. Systolic and diastolic blood
pressure of females in reproductive age (20-44 years) was lower than that of males (p<0.05). Both systolic and
diastolic blood pressures showed increase up to the age group of 50-54 years in males. Thereafter there was little
reduction in the values which was not statistically significant (p>0.05). In females there was a gradual increase in
blood pressure values with age. Significant (p< 0.05) mild correlation was observed between blood pressure values
and anthropometric characters. Conclusion: This study will be useful as there are no published data available for
healthy Sri Lankans Tamils.

Keywords: Diastolic Blood pressure, Sri Lankan Tamils, Systolic Blood Pressure

Introduction

Ischemic heart disease is a common cause of mortality Information on normal blood pressure values will be
in Sri Lanka. Hospital admissions due to ischemic heart useful in diagnosing hypertension, planning for
diseases are higher in Sri Lanka than that in developed prevention and in early treatment. Ethnic variations in
countries [1]. Increased blood pressure is an important blood pressure have been reported in the literature.
risk factor for cardiovascular diseases. It is also Blood pressures of Indian Children were lower than
associated with renal and cerebrovascular diseases. that of US children. Also the values were lower than
Increasing blood pressure is becoming a common Jordanians, Pakistanis and Iranians who had higher
problem in the world due to obesity, changing food values than US children [5]. Genetic, Social,
habits and sedentary life style. One in four adults is economical, cultural and environmental factors of Sri
reported to have hypertension in Sri Lanka Lankans differ from other ethnic groups. Published
[2].Defining hypertension depends on normal reference data available for blood pressure values of adults are
values of blood pressure. Individual variation in blood also limited. In Sri Lanka a large survey was done on
pressure occurs with sex, age, body weight [3], BMI blood pressure values to detect the prevalence of
[4], height [5], lean body mass [6] and total skin fold hypertension. This was done in 6047 participants aged
thickness [7]. In addition lack of physical activity, between 30-65 years from four provinces of Sri Lanka
consumption of alcohol and smoking may also namely Western, North Central, Southern and
influence blood pressure. Uva[8].Sinhalese people populate these districts
_______________________________ predominantly. This study used the cut off values of
*Correspondence world Health Organization (WHO) to detect
Balasubramaniam M hypertension. There are no published data for blood
Department of Physiology, Faculty of Medicine, pressure values of healthy Sri Lankans, which would
University of Jaffna, Sri Lanka. be better to define normal blood pressure. Using
E Mail: mathu1481@[Link]. foreign data in Sri Lankans may not be appropriate as
anthropometric characters differ from population to
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Asian Pac. J. Health Sci., 2015; 2(3):66-71 e-ISSN: 2349-0659, p-ISSN: 2350-0964
____________________________________________________________________________________________________________________________________________
population. Therefore, the present study was circumference of the buttocks with a non elastic
undertaken with the aim of establishing reference measuring tape. Waist Hip Ratio (WHR) and Body
norms of blood pressure values for Sri Lankan Tamils Mass Index (BMI) were calculated. Blood pressure was
in Jaffna district. measured in right arm by one qualified medical person
while the participant was sitting with supported back
Materials and method and the arm supported at the heart level. It was
confirmed that the person was resting for at least 5
This was a descriptive cross sectional study among the minutes before measuring the blood pressure. Mercury
healthy Sri Lankan Tamils living in Jaffna district. sphygmomanometer and standard stethoscope were
Ethical clearance was obtained from Ethical Review used to measure the blood pressure. Appropriate adult
Committee, Faculty of Medicine, and University of cuff that covers at least 80 % of the arm was used.
Jaffna. Volunteers above 15 years of age were Appearance and disappearance of the Korotkoff sound
recruited in such a way to have 80 males and females were taken as Systolic Blood Pressure (SBP) and
in age group of 5 years. Data was collected in schools, Diastolic Blood Pressure (DBP) respectively. Three
at divisional secretariats, by standers of patients measurements were taken with 5 minutes interval
attending various clinics in different MOH areas, at the between each measurement. Lowest reading was taken
technical college, at temples and among university staff for analysis. Data were analyzed in SPSS 16. Sex
as determined to represent people in Jaffna District. differences and differences between age groups were
Permission was obtained from each head of the assessed by independent T test. Pearson correlation
institution prior to the study. Written informed consent was used to get correlation between blood pressure
was obtained from each participant. An interviewer values and anthropometric characters.
administered questionnaire was used to get basic
information about participants. The participants were Results
recruited for the study if they were non smoking, not
consuming alcohol, free from already diagnosed Total of 1529 (615 males & 914 females) participants
hypertension and diabetes, no signs or symptoms were included in this study. The age range of males
related to cardiac or renal or any other diseases which was 15- 92 years and 17-85 years for females. Mean
could elevate blood pressure, mentally healthy and not height (cm), weight (kg) and BMI (kg/m2) of males
pregnant. were 169±7, 64.5±12.6 and 22.7±4 respectively. For
Age was calculated in years as on last birthday. Height females the respective values were 156±7, 54.7±4 and
was measured while the participant looks straight 22.6±4.6. HC and WC were 91±9 and 82±12
ahead while arms were either side of the body and back respectively in males. Females had HC and WC of
against the vertical support of the instrument. Weight 90±13, 78±14 respectively. Waist- Hip Ratio (WHR)
was measured without foot wears. Both height and was 0.9±0.07, 0.84±0.06 in males and females
weight were measured to nearest 0.5 cm and 0.5 kg respectively. There was a statistically significant
respectively using the Seca scale (Germany). Waist difference (p< 0.05) in anthropometric characteristics
Circumference (WC) was measured midway between of males and females except in BMI. Both males and
iliac crest and lower rib margin at the end of normal females were separately grouped in to age groups of 5
expiration with a non elastic measuring tape. Hip years. Blood pressure values of males and females in
Circumference (HC) was measured at the maximum different age groups are summarized in Table 1.

Table 1: Blood Pressure values (mean±SD) of different age groups

Age Males Females P values for sex

range differences
(years) No of SBP DBP No of SBP DBP SBP DBP
participants (mmHg) (mmHg) participants (mmHg) (mmHg)

15-19 89 112±14 69±12 83 109±10 70±10 0.066 0.748

20-24 96 120±13 78±11 153 113±12 74±10 0.000* 0.017*
25-29 68 122±16 79±11 99 112±12 75±10 0.000* 0.008*
30-34 72 125±14 82±14 120 113±13 76±9 0.000* 0.000*
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Asian Pac. J. Health Sci., 2015; 2(3):66-71 e-ISSN: 2349-0659, p-ISSN: 2350-0964
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35-39 66 123±14 83±12 103 115±14 77±9 0.000* 0.000*
40-44 55 128±18 88±14 76 122±15 80±11 0.032* 0.001*
45-49 32 131±21 87±16 72 127±20 83±13 0.342 0.170
50-54 28 132±16 86±11 69 127±18 83±13 0.205 0.157
55-59 36 131±18 85±14 46 126±18 81±11 0.162 0.098
60-64 26 129±19 82±11 37 135±20 85±12 0.181 0.248
>64 47 136±20 82±15 56 137±21 82±12 0.828 0.953
SBP- Systolic Blood Pressure DBP- Diastolic Blood pressure * - p < 0.05

Lower systolic and diastolic blood pressure in females blood pressure values. The change in SBP and DBP
compared to males were statistically significant was significant between 14-19 and 20-24 age groups
(p<0.05) in the age groups of 20-24, 25-29, 30-34, 35- only in both sexes. In other groups the increase was not
39 and 40-44 (females in reproductive age). Both statistically significant (p>0.05) compared to previous
systolic and diastolic blood pressures increase up to the age group. Pearson correlation between anthropometric
age of 50-54 years in males. Thereafter there was little and blood pressure values revealed significant (p<0.05)
reduction in the values which was not statistically mild correlation of blood pressure values with various
significant. In females there was a gradual increase in anthropometric characters (Table 2).

Table 2: Correlation coefficient blood pressure values with anthropometric characters

Anthropometric characters Males Females

SBP DBP SBP DBP
Age 0.348* 0.258* 0.475* 0.335*
Height 0.009 0.116 -0.121 -0.058
Weight 0.293* 0.394* 0.175* 0.239*
Waist circumference 0.393* 0.450* 0.211* 0.216*
Hip circumference 0.332* 0.401* 0.172* 0.186*
Waist-Hip ratio 0.291* 0.308* 0.169* 0.150*
BMI 0.316* 0.383* 0.229* 0.276*
SBP- Systolic Blood Pressure DBP- Diastolic Blood Pressure * p < 0.001

Although both systolic and diastolic blood pressures to the BMI cut off values for Asian adults [9]. This
have significant mild positive correlation with age, regrouping was necessary because dividing the original
SBP has higher correlation than DBP in both sexes. groups did not have adequate numbers for statistical
Influence of obesity indicators like BMI, WC, and analysis. Blood pressure values of each group are
WHR on Blood pressure values was studied. The given in Table 3. Also they were divided using Asian
participants were re-grouped into age of decades cut off values for WC and WHR [9] separately and
starting from 15- 24 years and then, each age group analyzed (Table 4 &5).
was divided into low, normal and high BMI according

Table 3: Blood pressure in different age groups according to BMI

Age BMI
group
Low (<18.5) Normal (18.5- 24.9) High(>25.0)
SBP DBP SBP DBP SBP DBP
Males
15-24 112±13(59) 72±18 116±14(89) * 72±12** 123±11(37) * 79±11**
25-34 118±18(18) 76±18 117±14(41) * 76±9** 128±14(81) * 84±11**
35-44 112±13(6) 69±15 123±16(35) 84±14 127±16(79) 87±11
45-54 130±9(3) 78±7 131±17(23) 84±9 131±20(33) 90±16
55-64 125±13(6) 75±8 124±19(24) * 81±13 135±17(31) * 87±12
>65 135±22(10) 83±13 138±18(22) 82±13 142±24(19) 88±17
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Asian Pac. J. Health Sci., 2015; 2(3):66-71 e-ISSN: 2349-0659, p-ISSN: 2350-0964
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Females
15-24 108±13(79) 71±9 111±10* (121) 73±4 118±9*(36) 75±7
25-34 108±12(28) 71±8 111±11*(77) 74±9** 115±13*(112) 77±9**
35-44 110±16(20) 72±12 114±14*(39) 76±9** 121±14*(99) 81±10**
45-54 120±15(10) 79±8 124±18(59) 81±11 128±20(90) 84±13
55-64 127±17(17) 79±10 131±21(30) 82±12 130±19(35) 84±11
>65 135±22(20) 83±13 138±18(17) 82±12 137±21(16) 80±10
* - SBP difference in both groups is significant at p <0.05 level
** - DBP difference in both groups is significant at p <0.05 level

Within each age group both SBP and DBP increased females, until the age of 44, higher BMI group had
with increase in BMI. Statistically significant increase significantly higher (p<0.05) blood pressure values
(p<0.05) in both SBP and DBP was noticed between than normal BMI group.
normal and high BMI group until 34 years in males. In

Table 4: Blood pressure based on WC

Age group SBP DBP SBP DBP

Males WC≤ 90 cm WC> 90 cm
15-24 116±14(177) 73±12 123±11(7) 82±10
25-34 122±15(107) * 79±12** 129±13(32) * 87±11**
35-44 123±15(67) 82±12** 128±17(51) 90±12**
45-54 129±18(36) 84±12 133±18(23) 91±13
55-64 126±17(34) 80±11** 133±19(22) 87±14**
>65 131±19(20) 78±13** 140±25(29) 88±18**
Females WC≤ 80 cm WC> 80 cm
15-24 111±12(189) 73±10 113±9(43) 72±10
25-34 111±13*(155) 74±10 116±12*(61) 77±9
35-44 115±15*(92) 76±10** 121±13*(83) 80±10**
45-54 121±17*(60) 76±10** 130±18*(78) 81±10**
55-64 128±18(52) 81±10 133±20(30) 84±13
>65 135±19(37) 81±12 137±23(13) 80±11
* - SBP difference in both groups is significant at p <0.05 level
** - DBP difference in both groups is significant at p <0.05 level

SBP and DBP were increased as WC increased in the (p<0.05) differences were observed until 54 years
same age group. DBP was significantly higher (p<0.05) between both groups. However in all the age groups of
in males who had higher WC than the Asian cutoff both sexes, SBP& DBP values increased as WC
values compared to those who had [Link] in the increased.
same age group. In females statistically significant

Table 5: Blood pressure based on WHR

Age group SBP DBP SBP DBP

Males WHR ≤0.9 WHR> 0.9
15-24 116±14(150) 73±13** 119±12(27) 79±11**
25-34 122±16(74) 79±14** 125±14(59) 83±11**
35-44 120±16(29) 82±15 127±16(85) 88±12
45-54 120±14(17) * 80±9** 133±16(39) * 88±13**
55-64 127±14(10) 81±7 128±17(42) 83±12
>65 131±20(9) 79±13 139±22(36) 85±6
Females WHR≤0.85 WHR> 0.85
15-24 111±12(152) 73±10 111±11(79) 72±10
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25-34 112±13(140) 74±9 113±13(76) 77±9
35-44 117±15(89) 77±10* 119±14(85) 80±11*
45-54 122±15(52) 81±9 128±19(86) 83±14
55-64 127±18(41) 81±10 133±20(40) 85±12
>65 132±22(23) 81±10 139±17(27) 81±13
* - SBP difference in both groups is significant at p <0.05 level
** - DBP difference in both groups is significant at p <0.05 level

In males, statistically significant differences (p<0.05) from diseases causing hypertension. Our data
in DBP were observed between participant who had collections were done at work places, clinics and public
normal and higher WHR. In females WHR did not places which could have increased the blood pressure
influence statistically (p>0.05) on blood pressure values due to anxiety and work stress. Even though
values. precautions were taken to rest them for at least 5
minutes, we could not assure that anxiety or stress did
Discussion not influence completely as we could not bring the
participants to laboratory and give complete rest. This
Blood pressure values of females in was a limitation in our study. The study of
reproductive age group were lower than males which Wijewardena et al was done a decade ago. Life style
was statistically significant (p<0.05). Thereafter there changes towards a sedentary life and increasing fast
was no significant difference between both sexes. After foods would have increased the blood pressure in our
age of 45, females who had higher BMI did not differ participants in addition to ethnic variation.
statistically (p> 0.05) from females of same age with However our study was done in large number
normal BMI. Increased blood pressure values in of healthy population. There are no published data
menopausal women have been reported by Stressen available for healthy Sri Lankan Tamils. Therefore this
etal [10]. This is explained by reduced estrogen to study provides useful information on blood pressure
testosterone ratio after menopause. We did not values of Sri Lankan Tamils in Jaffna district. Further
investigate menopausal age in our participants. studies in a convenient environment are essential for
However above 45 years most of the females would more accurate results.
have achieved menopause. This could have caused the
blood pressure of females similar to that of males Acknowledgement
above this age. Another possible reason could be our
sample sizes in groups above 45 years were smaller The authors acknowledge Mr. S. B. Rameshkumar, Mr.
which may have affected the results of statistical Pavalarajah and other staff at the Dept. of Physiology
analysis. for their help in arrangement. Dr Ramalingam
Increase in systolic and diastolic blood pressure with Nagaratnam Research fund from Faculty of Medicine,
age was consistent with other authors [8, 11, 12].This University of Jaffna and Jaffna University Research
can be explained by increase in stiffness of the arterial grant – 2014 are greatly appreciated.
wall due to the replacement of elastin fibers with
collagen. Statistically significant mild correlation of References
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Source of Support: Nil

Conflict of Interest: None

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