Hypertension and its association with behavioral risk factors for non-communicable diseases: insights from the 2021 Vietnam WHO STEPS survey

To estimate the prevalence of hypertension and examine its associations with individual and clustered behavioral risk factors among Vietnamese adults using nationally representative data from the 2021 Vietnam WHO STEPS survey. We conducted a cross-sectional, survey-weighted analysis. The hypertension prevalence analysis included 3,809 adults aged 18-69 years with valid blood pressure measurements, and multivariable regression analyses were conducted among 3,748 participants with complete data on hypertension, behavioral risk factors, BMI, and socio-demographic covariates. Behavioral risk factors included current tobacco smoking, current alcohol drinking, insufficient physical activity, and inadequate fruit/vegetable intake, examined individually and as an unweighted cumulative index ranging from 0 to 4. The survey-weighted crude prevalence of hypertension was 26.4%, with higher prevalence among men than women and a strong age gradient. In individual-risk-factor models, alcohol drinking and inadequate fruit/vegetable intake remained associated with higher odds of hypertension after adjustment. The cumulative behavioral risk factor index showed a graded association with hypertension, with the highest adjusted odds among participants with all four risk factors. These findings provide updated evidence on hypertension and behavioral risk factor clustering in Vietnam and support integrated NCD prevention and hypertension control strategies, while causal inference cannot be made.