Urban-rural disparities in hypertension prevalence, screening, and control in South Kivu Province, eastern Democratic Republic of the Congo.

BACKGROUND Socioeconomic development is gradually reducing in the prevalence of hypertension (HT) and associated risk factors between urban and rural areas.

OBJECTIVES To update data for the Democratic Republic of the Congo by examining differences in the prevalence and control of HT and other cardiovascular risk factors between urban and rural populations of Congolese adults.

METHODOLOGY During the May Measurement Month campaigns in 2023 and 2024, 4,012 participants aged ≥ 30 years (1,036 residing in the city of Bukavu and 2,976 in the rural areas of Kaziba and Katana) were interviewed and underwent measurements of blood pressure, weight, and height. HT was defined as blood pressure ≥ 140/90mmHg and/or current use of antihypertensive medication.

RESULTS Compared with urban participants, rural participants had a significantly higher prevalence of HT (33.4% vs. 27.8%; P=0.001), age >60 years (29.4% vs. 20.4%; P<0.0001), and smoking (27.6% vs. 14.0%; P<0.0001). Conversely, overweight (32.9% vs. 23.2%; P<0.0001), obesity (12.3% vs. 5.3%; P<0.0001), physical inactivity (32.9% vs. 11.8%; P<0.0001) and a history of diabetes mellitus (5.3% vs. 3.5%; P=0.01) were significantly more significantly more common in urban areas. Multivariate analysis indicated that rural residence (adjusted OR=1.55; P<0.0001) was an independent predictor of HT after adjustment for age, sex, BMI, smoking, diabetes mellitus, and physical inactivity.

CONCLUSION The findings suggest that the rural Congolese environment may contribute to hypertension due to an older age structure, the adoption of unhealthy behaviors, and low detection rates of HT. Enhanced awareness of HT diagnosis and promotion of healthy lifestyles are essential in these settings to mitigate this major cardiovascular risk factor.