Key result
Diabetes is linked to ~2.8-fold higher odds of hypertension over 5-year follow-up.
Why the study?
Hypertension is a significant public health concern in rural South Africa where healthcare access is limited, motivating a longitudinal assessment of its prevalence and associated risk factors among rural Black adults in Limpopo Province.
Cohort (n=518)
No
In a selectively retained high-risk rural South African cohort, hypertension prevalence rose from 43.8% to 46.9% over five years, driven consistently by older age (>=64 years), central obesity, and diabetes, supporting targeted community screening.
Associations with diabetes, central obesity, and age ≥64 support hypothesis generation; leaves open generalizability given attrition bias in this rural cohort.
Hypertension remains a significant public health concern in South Africa, particularly in rural areas where healthcare access is limited. This study aimed to longitudinally assess hypertension prevalence and associated risk factors among a retained cohort of rural Black adults in Limpopo Province. Prospective longitudinal cohort study of 518 participants followed from baseline (2014–2016) to follow-up (2019–2022). Data were analyzed using SPSS version 27.0, with binary logistic regression to determine factors associated with hypertension. Among the retained cohort ( n = 518), baseline hypertension prevalence was 43.8%, increasing to 46.9% at follow-up. Hypertensive participants were significantly older and more likely to be female. Adjusted analyses showed age ≥ 64 years (baseline aOR = 3.05; 95% CI:1.23–7.56; follow-up aOR = 2.72; 95% CI:1.43–5.18), central obesity (baseline aOR = 2.92; 95% CI:1.72–4.96; follow-up aOR = 2.60; 95% CI:1.69–3.99), and diabetes (baseline aOR = 2.92; 95% CI:1.38–6.17; follow-up aOR = 2.75; 95% CI:1.70–4.44) were consistently associated with hypertension. Notably, significant attrition bias was observed: baseline hypertension prevalence among retained participants was more than double that of those lost to follow-up (43.8% vs. 19.7%; p < 0.001), and retained participants had higher rates of obesity and diabetes but lower rates of kidney disease. In this selectively retained high-risk cohort, hypertension prevalence increased over five years, with age, central obesity, and diabetes as consistent risk factors. Due to substantial attrition bias, these findings should be interpreted as reflecting trends within a high-risk survivor sub-cohort rather than population-level prevalence estimates. The strong associations observed support targeted screening and intervention strategies for older adults, women, and individuals with obesity or diabetes in rural South African communities.
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Ntimana et al. (2026) conducted a cohort in Hypertension (n=518). Diabetes mellitus (along with age ≥64 years and central obesity as cardiometabolic risk factors) vs. No diabetes mellitus (and absence of risk factors) was evaluated on Hypertension prevalence at 5-year follow-up associated with diabetes (OR 2.75, 95% CI 1.70-4.44, p=<0.001). Diabetes (aOR 2.75), central obesity (aOR 2.60), and age ≥64 years (aOR 2.72) were consistently associated with hypertension as cohort prevalence rose from 43.8% to 46.9% over 5 years.
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