Unveiling the national epidemic of uncontrolled blood pressure in a low middle-income country: a nation wide multicenter study

Introduction. Hypertension is a major global issue with a higher prevalence in low- and middle-income countries than in high-income countries. This study aimed to examine hypertension control among patients attending specialist medical clinics across all nine provinces of Sri Lanka. Methods This nationwide multicentre study was conducted across the medical clinics of one apex hospital in all nine Sri Lankan provinces. All patients diagnosed with hypertension by a Consultant Physician and attending clinics over one month were recruited for the study. Blood pressure was considered under control if systolic and diastolic blood pressures were < 140 mmHg and < 90 mmHg, respectively, during the most recent visit. Analysis of variance (ANOVA) was used to compare whether the means were significantly different (using the F distribution). The prevalence of uncontrolled blood pressure was age- and sex-standardised using the WHO World Standard Population. Results Among the 2930 patients with hypertension, following age-standardization using the WHO World Standard Population, 51.8% of participants had uncontrolled blood pressure. The prevalence increased progressively with age, from 28.6% among those aged 20–24 years to 78.9% among those aged ≥ 85 years. Age-standardized prevalence was similar among females (54.2%) and males (53.8%). The mean systolic blood pressure increased with age, whereas the diastolic blood pressure peaked in middle age and declined in older age groups. The highest mean SBP (164.09 mmHg) was observed among males aged 60–74 years. 53% of patients lived in districts below the poverty line, with a significant difference in DBP. Conclusion More than half of the treated hypertensive patients had uncontrolled blood pressure after age standardisation. Blood pressure control worsened markedly with age, with the highest prevalence observed in adults aged ≥ 85 years. While the prevalence was similar between the sexes, men had higher blood pressure levels among those with uncontrolled hypertension. These findings highlight the need for intensified hypertension management, particularly among older adults, to improve blood pressure control and reduce cardiovascular risks.