Prevalence and Determinants of Uncontrolled Hypertension Among Treated Adults in a Rural Primary Health Care Facility in South Africa: A Cross-Sectional Study

Background: Hypertension remains one of the leading modifiable risk factors for cardiovascular diseases globally, yet blood pressure control remains suboptimal in many low- and middle-income countries. Understanding the prevalence of uncontrolled hypertension and its associated factors is important for improving treatment outcomes, particularly in rural primary health care settings. Methods: A cross-sectional study was conducted among 103 hypertensive patients receiving follow-up care at a rural community health centre in the Eastern Cape Province of South Africa between August and October 2024. Sociodemographic, lifestyle, and clinical information were collected using a semi-structured questionnaire and medical record review. Medication adherence was assessed using the Hill–Bone Compliance to High Blood Pressure Therapy Scale. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Associations between explanatory variables and uncontrolled hypertension were analysed using chi-square tests and multivariable logistic regression. Results: The mean age of participants was 63 ± 13 years, and 65% were female. The prevalence of uncontrolled hypertension was 63.1% (65/103), while 36.9% (38/103) achieved blood pressure control. The median systolic blood pressure was 149 mmHg (IQR: 135–163) and the median diastolic blood pressure was 84 mmHg (IQR: 76–89). Low medication adherence was significantly associated with uncontrolled hypertension (OR = 4.20, 95% CI: 1.75–10.09, p = 0.001). Forgetfulness and non-use of reminders were common barriers to adherence. Conclusions: Uncontrolled hypertension remains highly prevalent among treated patients in this rural setting. Low medication adherence was significantly associated with uncontrolled hypertension, suggesting that adherence support strategies warrant further investigation in similar resource-limited primary health care settings.