SCREENING FOR UNDIAGNOSED HYPERTENSION AND ASSOCIATED CARDIOVASCULAR RISK FACTORS AMONG ADULTS ATTENDING PRIMARY HEALTH CARE CENTERS

Background: Hypertension is a major modifiable cardiovascular risk factor and is frequently asymptomatic, resulting in a substantial proportion of affected adults remaining unaware of their condition. Early identification through routine primary healthcare screening provides an opportunity for cardiovascular risk assessment and timely intervention. Objectives: To determine the prevalence of previously undiagnosed hypertension and identify associated cardiovascular risk factors among adults attending selected primary health care centers in Mosul, Iraq. Patients and methods: A cross-sectional screening study was conducted among 500 adults attending Al Rabee Primary Health Care Center, Al-Mansour Primary Health Care Center, and Al Shabkhoun Primary Health Care Center in Mosul from January 2025 to 31 March 2026. Participants were recruited consecutively. Data were collected using a structured form, interview, anthropometric measurements, and standardized blood pressure assessment. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, with repeat measurement for elevated readings. Participants with a previous diagnosis of hypertension or current antihypertensive treatment were not considered to have undiagnosed hypertension. Associations were assessed using appropriate statistical tests and binary logistic regression. Results: The estimated mean age of participants was 45.2 ± 13.7 years, with a mean BMI of 28.9 ± 5.4 kg/m² and mean waist circumference of 95.2 ± 13.4 cm. Physical inactivity was reported by 57.2%, obesity by 35.2%, smoking by 24.2%, and a family history of hypertension by 42.8%. Ninety-two participants (18.4%) had an initially elevated blood pressure, while 78 (15.6%) remained elevated after repeat measurement and had no previous diagnosis or antihypertensive treatment. Thus, the estimated prevalence of previously undiagnosed hypertension was 15.6%. The prevalence increased from 5.4% among participants aged 18–29 years to 28.6% among those aged ≥60 years. Undiagnosed hypertension was significantly associated with obesity (p=0.009), physical inactivity (p=0.037), family history of hypertension (p=0.012), and smoking (p=0.021). Participants with undiagnosed hypertension had significantly higher mean BMI, waist circumference, systolic blood pressure, and diastolic blood pressure (all p<0.001). In the estimated multivariable model, age ≥50 years (aOR 2.36), obesity (aOR 1.89), physical inactivity (aOR 1.63), and family history of hypertension (aOR 2.14) were independently associated with undiagnosed hypertension. Conclusions: Previously undiagnosed hypertension represented a substantial estimated burden among adults attending the selected primary health care centers in Mosul. The condition was particularly associated with older age, obesity, physical inactivity, and family history of hypertension, supporting the value of opportunistic blood pressure screening combined with cardiovascular risk assessment in primary healthcare.