Introduction
Hypertension is a prominent and significant chronic condition in all societies. The significance of this disorder has escalated due to its rising occurrence and extensive and harmful effects, including cardiac, cerebral, renal, and ocular complications [10]. The high prevalence of this disease and its recognition as a significant global public health problem can be attributed, in part, to the phenomenon of population aging [5]. The occurrence of this disease and the likelihood of serious complications are closely linked to the age of the affected individuals [8]. Given the significance of this disease from health, economic, and social viewpoints [1] and Iran’s upcoming challenge of dealing with a widespread increase in the elderly population [4], this study aims to examine the prevalence of high blood pressure complications and identify related factors among the elderly population in Semnan, Iran, in 2022.

Methods
The present cross-sectional study included 400 elderly individuals and used a researcher-made questionnaire. The initial questionnaire was developed by identifying severe complications of high blood pressure and relevant demographic and background factors through text review and interviews with experts. Subsequently, the content validity of this tool was assessed using the appropriate checklist on a four-point Likert scale and the perspectives of 10 experts based on four essential criteria: necessity, relevance, clarity, and simplicity in understanding. This assessment’s result confirmed the questionnaire’s content validity with scores of 0.95 and 0.98 for the CVR and CVI indices, respectively. Additionally, the reliability of the questionnaire was confirmed through internal consistency assessment using the test-retest method on 50 samples, yielding a Cronbach’s alpha score of 0.895. Furthermore, the data on elderly individuals with high blood pressure were extracted from the health information system of the Deputy of Health at Semnan University of Medical Sciences, and sampling was conducted randomly. The interviewer collected the necessary data by posing questions to the participants and documenting their answers on the questionnaire. Descriptive analyses were performed on the data, presenting quantitative variables as means (standard deviations) and qualitative variables as frequencies (percentages). The analysis section used the chi-square test to examine the statistical relationship between demographic and background variables related to various complications of high blood pressure. These analyses were conducted using SPSS software, version 27, and in all cases, a significance level of P≤0.05 was considered.

Results
The results indicate that 26.75% of the elderly participants are grappling with severe complications of hypertension. The rates of prevalence of complications and heart failure, retinopathy, renal failure and complications, heart attack, and stroke were 14.3%, 7.5%, 5.5%, 4%, and 1.5%, respectively. Accordingly, heart failure and complications, retinopathy, and renal failure and complications account for the highest proportion of the prevalence of these complications. The statistical analysis of the defined categories for demographic and background variables concerning the occurrence of complications of high blood pressure reveals that elderly individuals with higher age, a deceased spouse, lower education, a longer time since the initial diagnosis, a lack of disease control, reliance on free public healthcare, a history of not receiving recommended essential care, and receiving financial assistance for treatment expenses are significantly more affected by the complications of the disease, especially cardiovascular complications. Furthermore, elderly individuals with inadequate disease control are more prone to heart attacks than others. Illiterate elderly individuals, with longer intervals between diagnosis and commencement of care, neglecting proper and continuous disease control, and receiving financial assistance from others for their care expenses, face a higher risk of stroke. Moreover, elderly individuals with longer intervals between initial diagnosis and commencement of care, as well as those receiving care from general practitioners, are more likely than others to suffer from renal complications of high blood pressure, and elderly individuals who neglect proper and timely disease control, as well as those with a history of not receiving recommended care from physicians, are more affected by retinopathy than others (P≤0.05). (Table 1) 






Conclusion
The incidence of hypertension problems among the aged population in Semnan, Iran, is unfavorable, with over 25% of individuals experiencing severe effects from these complications. Among these complications, heart failure, retinopathy, and renal failure have accounted for the highest prevalence, and the incidence of heart and brain strokes is also significant. Additionally, a broad spectrum of demographic factors (age, education level, marital status), contextual factors (time elapsed since diagnosis), and health-seeking behaviors (time interval between diagnosis and commencement of care, disease control, the physician, history of not receiving essential care) are associated with the prevalence of complications of high blood pressure in the elderly. Researchers hope that the analysis of the current situation and the practical recommendations provided by this study can assist health managers and policymakers in making informed decisions and implementing effective interventions to enhance outcomes.

Ethical Considerations

Compliance with ethical guidelines
A written informed consent was obtained from all participants. They were free to leave the study at any time, and were assured of the confidentiality of their information. Ethical approval was obtained from the Ethics Committee of Semnan University of Medical Sciences (Code: IR.SEMUMS.REC.1400.211).

Funding
This study was funded by Semnan University of Medical Sciences. 

Authors' contributions
The authors contributed equally to preparing this paper

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to express their utmost gratitude to the participants for their cooperation in this study, and also thank the Deputy for Research and Technology of  Semnan University of Medical Sciences for the financial support.



 

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