Hypertension care cascade in Nepal: findings from Nepal Demographic and Health Survey 2022

BackgroundHypertension is a leading risk factor to Nepals rising burden of cardiovascular diseases, yet many affected individuals remain undiagnosed, untreated, and uncontrolled. Identifying gaps in care and variations across socio-demographics and provinces can help optimize interventions to prevent and control hypertension. ObjectivesWe aimed to quantify the prevalence and gaps in hypertension awareness, treatment, and control, as well as their determinants, using the latest nationally representative data from the 2022 Nepal Demographic and Health Survey (NDHS). MethodsWe used the NDHS 2022, conducted from January 5 to June 22, 2022. Socio-demographic factors such as sex, education level, age, body mass index (BMI), marital status, and residency were used to examine hypertension care cascade metrics. Logistic regression was used to assess the factors associated with each outcome above. ResultsA total of 9,990 unweighted observations, representing 10,065 participants (4,321 males and 5,744 females) aged [≥]15 years were included in this study. The national prevalence of hypertension was 200%. In multivariate analysis, male sex, older age, lower education level, married/divorced individuals, higher BMI, and urban residence had increased odds of hypertension. Among hypertensive patients, 502% were aware of their diagnosis, 317% were receiving treatment, and 180% had controlled blood pressure. There were substantial variations across the seven provinces in hypertension prevalence, ranging from (142%) in Karnali to (255%) in Koshi. The unmet need for hypertension diagnosis, treatment, and control was highest in Sudurpaschim province. ConclusionIn this cross-sectional survey study, about one out of every five Nepalese are hypertensive. Furthermore, the gaps in the hypertension care cascade are huge, with over 80% of adults with hypertension are either undiagnosed, untreated, or treated but with uncontrolled hypertension. Targeted and de-centralized improvements in access to early hypertension diagnosis and affordable treatment are especially crucial for low-income households, remote areas, and younger populations.