Physical activity and hypertension amongst HIV-positive and HIV-negative populations in rural South Africa

Hypertension represents a major public health challenge in sub-Saharan Africa, characterised by substantial underdiagnosis and inadequate management. This secondary analysis of cross-sectional survey data examined the association between physical activity patterns and hypertension prevalence amongst HIV-positive and HIV-negative populations in rural South African communities. Data were drawn from the ongoing Agincourt Health and Socio-Demographic Surveillance System Site (AHDSS), collected between August 2022 and May 2023, involving 4,436 participants aged ≥ 15 years. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) within the WHO STEPwise framework, and blood pressure was measured using an automated digital device (OMRON R6 wrist monitor). Statistical analyses employed chi-squared tests, two-sample t tests, and multivariable logistic regression models adjusting for demographic, anthropometric, metabolic, and behavioural confounders. Moderate physical activity was associated with lower odds of hypertension irrespective of HIV serostatus, supporting the integration of physical activity counselling into HIV care and primary healthcare services in resource-limited settings (adjusted OR = 0.74, 95% CI: 0.56–0.99, p = 0.043). Hypertension prevalence was 40.4% overall. HIV-positive males demonstrated higher prevalence (60.2%) compared with HIV-negative males (46.9%, p < 0.001). HIV-positive status was independently associated with increased odds of hypertension (adjusted OR = 1.45, 95% CI: 1.18–1.78). Age, male sex, obesity, elevated waist-hip ratio, and current alcohol consumption showed significant positive associations with hypertension. Moderate physical activity provides protective benefits against hypertension irrespective of HIV serostatus, supporting the integration of physical activity counselling into HIV care and primary healthcare services in resource-limited settings.