Prevalence of hypertension and estimates of cardiovascular disease risk in the Western Province of Sri Lanka

BACKGROUND: Ischaemic heart disease remains the leading global cause of death, and is strongly linked to hypertension. However, recent data on hypertension and cardiovascular risk in Sri Lanka are limited. This study aimed to determine the prevalence of hypertension, its associations with demographic characteristics, and the cardiovascular risk profile of the population in the Western Province of Sri Lanka. METHODS: A descriptive cross-sectional epidemiological study was conducted in 2018-2020 in Western province. A total of 1800 non-institutionalized adults aged over 20 years were recruited using a multi-stage stratified random cluster sampling method. Data collection was made through interviewer administered questionnaire, physical measurements, and laboratory investigations of biochemical analysis. Hypertension was diagnosed based on the 2017 guidelines of the American College of Cardiologists/American Heart Association. Cardiovascular risk was assessed using the WHO Cardiovascular Disease Risk Laboratory-Based Chart for the South-East Asia region and the Framingham Risk Score (FRS). Prevalence estimates are presented with 95% confidence interval. RESULTS: Data from 1,333 participants (response rate 78.2%) were analyzed; 62.3% were females, 36.4% lived in urban areas, and the mean age was 49.8 years (± 9.1) (males- 49.7 ± 8.93, females-49.8 ± 8.99). Age-standardized prevalence of hypertension among all adults was 47.2% (95% CI: 44.5-49.9). Crude prevalence was 56.3% (95% CI: 52.1-60.5), undiagnosed prevalence was 32.9% (95% CI:28.4-37.4) and already diagnosed was 23.4% (95% CI:20.2-26.6). Hypertension prevalence was highest among adults aged 60-69 years (75.5%, 95%CI:68.8-82.2), those with primary education (62.6%, 95% CI:52.7-72.5), in Gampaha district (57.3%, 95% CI:53.0-61.6), rural setting (57.2%, 95% CI:53.6-60.8) and with lowest monthly income of USD < 200 (59.8%, 95% CI:52.7-66.9). Among adults aged 40 years and older, the prevalence of high cardiovascular risk (> 20%) was 19.3% (95% CI:16.1-22.5) based on the FRS and 5.4% (95% CI:3.5-7.3) according to the WHO Risk Score. CONCLUSIONS: Over half of adults in Western Province, Sri Lanka have hypertension, with one-third undiagnosed. Nearly one-fifth of midlife adults face high cardiovascular risk. Socioeconomic disparities highlight the need for targeted workplace screenings and tailored health education for lower-income communities.