Untreated, uncontrolled and below-target hypertension in southern Africa

A population-based prevalence and care cascade assessment in rural Lesotho

Bibliographic Data

ID21878878
AuthorsIliana Margarita Esquivel-Valdes (University of Basel), Giuliana Sanchez-Samaniego (0000-0002-7208-3007, University of Basel), Ravi Gupta (0000-0003-2583-563X, SolidarMed Lesotho, Maseru, Lesotho), Thesar Tahirsylaj (0009-0002-6776-1499, University of Basel), Fabian Raeber (0009-0008-7113-0546, University of Basel), Mamakhala Chitja (SolidarMed Lesotho, Maseru, Lesotho), Malebona Mathulise (SolidarMed Lesotho, Maseru, Lesotho), Thuso Kabi (SolidarMed Lesotho, Maseru, Lesotho), Mosoetsi Mokaeane (SolidarMed Lesotho, Maseru, Lesotho), Malehloa Maphenchane (SolidarMed Lesotho, Maseru, Lesotho), Molulela Manthabiseng (SolidarMed Lesotho, Maseru, Lesotho), Makhebe Khomolishoele (SolidarMed Lesotho, Maseru, Lesotho), Mota Mota (SolidarMed Lesotho, Maseru, Lesotho), Sesale Masike (SolidarMed Lesotho, Maseru, Lesotho), Matumaole Bane (SolidarMed Lesotho, Maseru, Lesotho), Mamoronts’sane P Sematle (SolidarMed Lesotho, Maseru, Lesotho), Retsélisitsoe Makabateng (SolidarMed Lesotho, Maseru, Lesotho), Lebohang Sao (Ministry of Health), Mosa Tlahani (Ministry of Health), Pauline Grimm (SolidarMed Switzerland, Lucerne, Switzerland), Thilo Burkard (University Hospital of Basel), Frédérique Chammartin (0000-0001-8959-2724, University of Basel), Alain Amstutz (0000-0003-1716-993X, University of Basel), Felix Gerber (0000-0002-9736-1907, University of Basel), Niklaus Daniel Labhardt (0000-0003-3599-1791, University of Basel)
LanguageEN
References cited50

INTRODUCTION: Hypertension programmes have expanded substantially in low-income and middle-income countries, yet treatment and control rates remain insufficient. Programme scale-up may lead to suboptimal health outcomes and resource allocation if diagnostic accuracy, monitoring and treatment protocol adherence are inadequate. This study aimed to estimate the prevalence of untreated, uncontrolled and below-target hypertension in rural Lesotho, and to identify factors associated with each condition. METHODS: We conducted a population-based cross-sectional study nested within the Community-Based Chronic Care Lesotho (ComBaCaL) cohort study (NCT05596773). Adult cohort participants ≥18 years were eligible for home-based standardised blood pressure (BP) measurement. Hypertension was defined by averaged elevated BP measurements or current use of antihypertensive medication. Uncontrolled hypertension was defined as on-treatment BP ≥140/90 mm Hg, and below-target hypertension as on-treatment systolic BP <110 mm Hg. Multivariate regression models were conducted to identify associated factors. RESULTS: Between 8 September 2023 and 10 February 2025, 8236 adult participants were screened, with 18.3% (n=1505) diagnosed with hypertension. Of those diagnosed, 75.1% (n=1130) were on treatment and 24.9% (n=375) untreated. Among those on treatment, 53.5% (n=605) were controlled, 26.3% uncontrolled (n=297) and 20.2% (n=228) below target. Female sex, age ≥65 years, diabetes and a history of stroke or myocardial infarction were associated with lower odds of being untreated, while smoking and alcohol consumption increased these odds. Taking ≥3 antihypertensive drugs and non-adherence were associated with a higher risk of uncontrolled hypertension. Dual antihypertensive therapy was associated with a lower risk of being below target, while a history of stroke or myocardial infarction increased this risk. CONCLUSIONS: Despite higher-than-expected hypertension treatment and control rates, substantial gaps remain, including untreated, uncontrolled and below-target hypertension, underscoring the need to strengthen diagnostic accuracy, monitoring and adherence to treatment protocols, with particular attention to high-risk groups

MEDLINE · Public health · Rural area · Rural health · Rural population · Blood Pressure and Hypertension Studies · Global Maternal and Child Health · Global Public Health Policies and Epidemiology