Regional Disparities in Undiagnosed Hypertension Among South Asian Adults in the Bay Area and Central Valley: The PRANA Heart Study

Background South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) experience a disproportionately high burden of cardiovascular disease, with hypertension serving as a major modifiable risk factor. Despite this elevated risk, hypertension often remains underdiagnosed, particularly in community settings with limited access to routine screening. This study assessed the prevalence of hypertension and undiagnosed hypertension among South Asian adults participating in community-based health screenings in Northern California and examined regional disparities between the San Francisco Bay Area and the Central Valley. Methods A cross-sectional survey-based study was conducted among adults attending screenings organized by Jeeva Clinic at religious and community institutions. Participants voluntarily completed a survey collecting demographic information, cardiovascular health history, lifestyle factors, and recent blood pressure measurements obtained either during screening or through self-report. A total of 300 participants were included in the final analysis. Results Among participants with sufficient blood pressure data for hypertension classification (n = 245), 82.9% met criteria for hypertension. Among participants with sufficient data to determine undiagnosed hypertension status (n = 244), 59.8% exhibited previously undiagnosed hypertension. Hypertension prevalence was significantly higher among participants in the Central Valley than among those in the Bay Area (97.9% vs 71.0%; chi-square = 31.2; p < 0.001). Undiagnosed hypertension was also substantially more prevalent in the Central Valley (91.7% vs 37.0%; chi-square = 71.0; p < 0.001). In multivariable analysis, Central Valley residence was associated with significantly higher odds of hypertension (OR = 14.29; 95% CI, 2.89 to 70.63; p = 0.001), and higher BMI was independently associated with hypertension (OR = 1.26 per unit increase; 95% CI, 1.10 to 1.43; p < 0.001). Conclusions These findings highlight a high burden of hypertension and significant regional disparities among South Asian adults in Northern California, suggesting that a large proportion of cardiovascular risk in this population remains undetected in routine care settings. Community-based screening initiatives, such as Jeeva Clinic, may help identify individuals at elevated risk and improve early detection in underserved populations.