## 4 Discussion
The literature documents that, until the age of 50 to 60 years, both SBP and DBP increase with age. Over the age of 60 years, in the majority of cases, SBP increases with age [57]. Elevated SBP is attributed to arterial stiffness as a major cause [57], and, among older persons, SBP is a superior marker of cardiovascular risk than DBP [58]. Although no significant difference in overall hypertension and increased SBP and DBP was observed between men and women in this study, the prevalence was slightly higher in men. The disproportion between genders in terms of hypertension prevalence that was observed in this study is consistent with several studies that report men to be more affected than women in developing countries [17; 51; 53; 54]. Additionally, overweight/obesity (82%) and abdominal obesity (57%) were also high among older persons in this study. Obesity has been reported among older persons in South Africa (72.4%) [26], but the prevalence was high compared to studies in other African countries, e.g., Ghana (39.5%) [59] and Ethiopia (23.9%) [17], and lower in Malawi (21.9%) [60] and Nigeria (29.2%) [61]. [PERSON] [62] reported that obesity among older persons is fuelled by several factors from social, environmental, genetic, etc. perspectives. There is a possibility that a diminishing energy expenditure, predominantly in older persons aged 50 to 65-years, interferes with body fat that increases with age. However, consequent fat accumulation among older persons aged \(\geq\)65 years could be attributed to hormonal changes accompanied by aging [62]. This study also showed a significant relationship between obesity indicators (WC, BMI and WHtR) and overall hypertension or either increased SBP or increased DBP in men and women, separately, and among older persons, collectively. Multivariate analysis showed that WC was significantly associated with hypertension after adjusting for marital status, education, old age grant and family history of hypertension. Generally, WC (64%) was a better predictor, followed by WHtR and BMI, with AUC around 60% in this study. Furthermore, most studies have reported a relationship between WC and hypertension among older persons [63; 64], since WC may be a better indicator of total body fat rather than visceral fat [65]. WC is an indicator of abdominal obesity, linked to inflammation and contributing to the risk of CVD [66]. It is worth noting that BMI and WHtR [67] have been reported alongside WC as predictors of hypertension among both men and women in this study. Studies have reported that WHtR is more valued than BMI and WC in predicting hypertension [31; 68; 69]. While the risk of developing hypertension was greater with increased BMI compared to WC [70], other researchers suggest that visceral adiposity is generally a stronger predictor of hypertension than BMI-based measures [71]. Therefore, the current study showed that, with the exception of WHtR, all other obesity indicators (WC, WHtR and BMI) are predictors of hypertension in South African older persons. [PERSON] et al. [72] have summarized that BMI does not differentiate between fat or lean mass, and it does not separate the location of central or peripheral fat; therefore, WC and WHR are the proposed indicators of abdominal obesity for their relation with fat distribution. On the other hand, WC is a limited indicator since it does not take an individual's height and weight into account, therefore overestimating and underestimating obesity among individuals who are either tall or short, respectively [72]. WHt has no benefit over WC alone, and it is infrequently used during the routine evaluation of obesity. On the other hand, a meta-analysis has shown that BMI, WC and BMI are similarly related to hypertension [72]. Furthermore, WHtR has been recommended as a determinant of metabolic and cardiovascular abnormalities since it is suggested to reduce limitations of BMI, WC and WHR [72]. Therefore, the use of a combination of obesity indicators, especially WC, WHtR and BMI, in various population groups provides important information.