Prevalence, associations and sex-related disparities of hypertension in South Asians: Evidence from a national survey of Sri Lanka

BACKGROUND: Blood pressure(BP) control remains suboptimal worldwide. Sex-related disparities in hypertension have been reported, but data from South Asia are limited. Understanding the epidemiology and sex-related differences is essential to improve BP control. OBJECTIVES: To assess the prevalence, associations and sex-related disparities of hypertension among Sri Lankans. METHODS: We analysed secondary data from the Sri Lanka STEPS Survey 2021, a nationally representative, community-based, cross-sectional study. Hypertension was defined as BP ≥ 140/90 mmHg or current antihypertensive use; controlled BP as BP < 140/90 mmHg. Prevalences, associations, and sex-related disparities in hypertension, undiagnosed hypertension, and BP control were assessed using logistic regression. RESULTS: Data from 4,634 adults(mean age 43.5(weighted CI 43.0-44.1) years; female 54.8 (53.1-56.5)%) were analysed. Overall, 37.2(35.5-38.9)% had hypertension, of whom 60.0(58.1-63.4) % were previously undiagnosed. Among those previously diagnosed, 73.6 (73.6, 69.6-77.2)% were on treatment, but only 38.0(33.0-44.20)% achieved BP targets. The rates of hypertension prevalence (p = 0.600), treated hypertension (p = 0.398), and controlled blood pressure (p = 0.819) in females and males did not differ significantly by sex. However, undiagnosed hypertension was significantly higher in males (69.4%, 65.3-73.1) than in females (53.6%, 50.1-57.0) (p < 0.001). Differences in the associations of hypertension by sex were noted; diabetes was associated only in females (p < 0.001), while wealth quintile (p < 0.001) and 24-hour urinary salt excretion (p = 0.011) were associated only in males. Overweight/obesity was shown to have a significant association with undiagnosed hypertension only in males (p = 0.017) in stratified analyses. CONCLUSIONS: More than half of the hypertensives in this South Asian population were previously undiagnosed. Of hypertensives, ¾ were treated, but only 1/3 achieved treatment goals. Prevalence, treatment and control rates of hypertension were not different between females and males, but undiagnosed hypertension was more common in men. Therefore, the emphasis should be on improving the detection of hypertension, especially in men, and on treating to targets in both sexes.