Undiagnosed and Uncontrolled Hypertension in the Aseer Region, Saudi Arabia: A Ramadan Screening Study with Long-Term Trends (1990–2019) and Projections to 2027

Faisal Saeed Al-Qahtani,1 Safar Saad Battar,2 Muammar Hassan Musharraf,3 Ali Mohammed AlAmri,4 Awad Alsamghan,1 Ayoub Ali Alshaikh,1 Mozoun Dafer Alahmari,3 Ramy Mohamed Ghazy1,5,6 1Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia; 2King Khalid University Medical City, King Khalid University, Abha, 61421, Saudi Arabia; 3Ministry of Health, Abha, 61421, Saudi Arabia; 4Department of Family Medicine and Diabetes, Joint Program of Family Medicine Southern Region, Abha, 61421, Saudi Arabia; 5Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt; 6Health and Medical Research Centre, King Khalid University, Abha, 61421, Saudi ArabiaCorrespondence: Ramy Mohamed Ghazy, Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia, Tel +201013828925, Email [email protected]: Community-based screening initiatives can facilitate early detection and link individuals to care. This study aimed to assess the prevalence of diagnosed and undiagnosed hypertension among adults in the Aseer region during Ramadan and contextualize these findings within national hypertension trends using World Health Organization (WHO) data from 1990 to 2019, with projections to 2027.Methods: A cross-sectional study was conducted from March 11– 18, 2025, including 657 adults. Participants were classified as non-hypertensive, previously diagnosed, or having undiagnosed hypertension. Multinomial logistic regression was used to identify factors associated with hypertension status. Secondary analysis of WHO data was performed to examine national trends in hypertension prevalence and projection using autoregressive integrated moving average (ARIMA) and Poisson regression models.Results: Primary data revealed that 56.3% had undiagnosed hypertension (stage 1: 43.8% and stage 2: 56.2%) and 16.6% had a prior diagnosis (stage 1: 27.5% and stage 2: 62.4%). Older age (adjusted odds ratio (aOR): 17.17, 95% CI 4.80– 61.42 for ages 55– 64), male sex (aOR: 2.24, 95% CI 1.16– 4.33), higher body mass index (aOR: 1.10, 95% CI 1.05– 1.15), diabetes (aOR: 2.23, 95% CI 1.14– 4.37), and self-reported dyslipidemia (aOR: 3.52, 95% CI 1.72– 7.24) were independent predictors of diagnosed hypertension. Male sex and higher BMI were also significant predictors of undiagnosed hypertension. Between 1990– 2019, secondary data revealed that females showed a significant decline in the prevalence of hypertension from 34.1% (95% CI: 21.5– 49.2) to 30.2% (95% CI: 21.4– 40.1) (APC: − 0.58%), while prevalence among males increased from 34.4% (95% CI: 21.5– 49.1) to 36.3% (95% CI: 26.6– 46.7) (APC: 0.18%). Overall prevalence decreased slightly from 34.4% (95% CI: 24.9– 45.1) to 34.0% (95% CI: 27.1– 41.5) (APC: − 0.4%). Forecasts for 2027 predicted a continued decline among females to 27.47% (95% prediction interval (PI): 26.42– 28.51) (APC: − 2.73%) and a modest increase among males to 36.82% (95%PI: 36.55– 37.09) (APC: 1.4%), with the total prevalence projected to decrease slightly to 33.39% (95%PI: 32.64– 34.14) (APC: − 1.01%).Conclusion: Ramadan-based screening revealed a high burden of undiagnosed and uncontrolled hypertension. Along with forecasts of rising male but falling female prevalence, this underscores the urgent need for targeted community-based screening, education, and management to improve hypertension awareness and control.Plain Language Summary: During a community health screening held in the holy month of Ramadan in Saudi Arabia’s Aseer region, nearly three out of every four (72.9%) of screened participants were found to have high blood pressure. Alarmingly, more than half of them had never been diagnosed (56.3%). Even among those who already knew they had high blood pressure, the majority still had levels that were not under control. The study also looked at national health data from 1990 to 2019 and made projections to 2027. While high blood pressure has been declining among women over the past three decades, it continues to rise among men and is expected to keep increasing through 2027. Men face higher risks than women, and having obesity, diabetes, or older age all increase the chances of having the condition. These findings show that relying on routine medical visits alone is missing most cases of high blood pressure. Urgent action is needed to make blood pressure screening a regular practice, especially targeting high-risk groups like men and people with excess weight, and to improve follow-up care so that those who are diagnosed get their blood pressure under control.Keywords: hypertension, undiagnosed hypertension, community screening, Ramadan, Saudi Arabia, blood pressure control