The findings of the prevalence of hypertension and associated risk factors among adults aged 25–65 years from Ndorwa west HSD community based study, revealed a prevalence of hypertension of 28.3%. This prevalence is slightly higher compared to Western Uganda region and other Ugandan rural areas, which were 26.3% and 25.8%, respectively [8]. It is also higher than prevalence in a similar setting study in Burkina Faso, which reported 18% [14]. the prevalence however was lower compared in a study conducted in similar setting in Sudan, which reported a 40.8% prevalence15.
The prevalence of hypertension in Ndorwa HSD however is consistent with findings from two community based studies in Ethiopia, which reported 28.3% and 27.4% [16, 17]. It also concurs with that reported in rural areas of the central region of Uganda of 28.5%8.
The high prevalence in this community based study is most likely due to an increase in adoption of modern lifestyles characterized by less exercise and high fat diet, which could be linked with an increased prevalence of obesity since less than half of the participants (44.9%) had Normal BMI > 24.5kg/m2. In this study, BMI was significantly associated with hypertension (p = 0.013). BMI > 24.9 kg/m2 compared to < 25 kg/M2 increased the odds of developing hypertension by 0.79. Therefore, Ndorwa HSD should not delay initiating interventions that improve physical activity and a healthy diet through community-based strategies that incorporate informational, behavioral, and social policy-making.
Although females had a higher pre-HT and HT prevalence than men, sex was not found to be significantly associated with HT. However, the observed difference can be explained by the fact that females engage in less physical activity at home, which makes it easier for them to accumulate fat and become more obese, and hence more prone to developing hypertension18.
The prevalence of pre-HT was 47.5%, which was higher than 30.6% reported by meta- analysis studies conducted in Middle East and North Africa [19], and in Nepal [20].
The high prevalence of pre-HT represents an increased risk of developing hypertension and other associated cardiovascular diseases. Pre-HT progresses to clinical hypertension at a rate of 19% over four years [21, 22]. Therefore, it is important to note that a high prevalence of pre-HT reflects an emerging public health concern because of progression to hypertension and other associated CVDs. This calls for the need to strengthen Hypertension and other NCD prevention programs to prevent the progression to hypertension and reduce related CVDs.
Behavioral factors associated with HT included awareness of BP status, reduced salt intake, use of fat/oil for cooking, and overweight and obesity.
The study noted that 89.5% had ever had their BP measured at least once, and 87.8% were aware of their blood pressure status contrary to2 finding of 90% not aware of their BP status. This means that remaining 12.2% are still unknowingly at risk of HT and its complications, since it is a silent killer [4]. Those with a BP status are more likely to take up HT prevention compared to those who are not and have reduced odds of developing HT.
Reduced salt intake was associated with lower odds of developing HT. Among those who reported high salt intake, one out of three were hypertensive and approximately one out of two were pre-hypertensive.
Activity, which included any form of physical exertion such as walking up a hill/cycling or digging, was not significantly associated with the development of HT.
The use of fat/oil is another significant factor in this study. The odds of developing HT were higher among those who used fat/oil for cooking than among those who did not. Cooking with fats/oils increased the odds of HT development by 0.73.
This study did not find any significant association between HT, alcohol consumption, and smoking. This finding differs from studies that have indicated a significant association between HT and smoking, alcohol consumption, and fruit and vegetable consumption. This could be due to the indication of different risk factors for hypertension in Ndorwa West HSD among the Bakinga, since they accounted for the majority (86.5%). However, this is consistent with a study a previous study [23] done in Bangladeshi that did not find a significant association between smoking, fruit and vegetable consumption, and HT.
This community-based cross-sectional study had several limitations. This study established an association between HT and a number of risk factors and estimated their risks using odds ratios. As this was a cross-sectional study, it lacked the ability to establish causal relationship between observed associated risk factors and HT. HT was defined as the average of three BP readings taken at least 1 min apart and measured at the field level instead of the clinical setting level. The study also did not collect data on several other factors that are often associated with hypertension, such as a family history of HT, waist circumference, and cholesterol levels.
However, this study used a standard and pre-tested WHO STEPs questionnaire tailored to the study setting. The WHO STEPs questionnaire is widely used and, therefore, provides a reliable comparison of our findings with those of other studies.