Socio-demographic, behavioral, and biological risk factors of hypertension in Kazakhstan: results of a national study

Abstract Background Arterial hypertension (AH) is a major contributor to cardiovascular morbidity and mortality worldwide. This study aimed to identify sociodemographic and biological factors associated with hypertension in a nationally representative adult sample in Kazakhstan. Methods A cross-sectional WHO STEPS survey (October 2021–May 2022) included 6,720 adults aged 18–69 years from all regions of Kazakhstan. Sociodemographic, behavioral, physical and biochemical data were collected, hypertension was defined by ESC/ESH criteria. Results Crude AH prevalence was 16.0% (95% CI 15.1–16.8) and increased sharply with age from 3.0% at 18–24 years to 46.7% at ≥ 65 years ( p < 0.001). Men had higher systolic (SBP) and diastolic blood pressure (DBP) than women (126/82 vs. 119/79 mmHg, p < 0.001) and a less favorable BP profile. Urban residents were younger and more likely to report smoking and alcohol use than rural residents (21.4% vs. 14.8% and 6.5% vs. 3.2%, p < 0.001), whereas rural participants had higher BMI, SBP, DBP, total cholesterol and HbA1c ( p < 0.05). Hypertension prevalence showed marked regional heterogeneity, from 9.5% in Kyzylorda and 9.6% in Astana to 25.3% in Akmola and 23.7% in North Kazakhstan. In adjusted models, hypertension was independently associated with older age (OR 1.894, 95% CI 1.780–2.014, p < 0.001), higher BMI (OR 1.597, 95% CI 1.484–1.719, p < 0.001), higher total cholesterol (OR 1.171, 95% CI 1.098–1.249, p < 0.001) and urban residence (OR 1.304, 95% CI 1.121–1.517, p = 0.001), while female sex was protective (OR 0.596, 95% CI 0.511–0.696, p < 0.001). Smoking, HbA1c, education and ethnicity were not significant after adjustment, and alcohol intake showed a statistically detectable but clinically minimal association (OR 0.997, 95% CI 0.995–0.999). Conclusion In 2021–2022, hypertension affected roughly one in six adults in Kazakhstan and rose steeply with age. Modifiable metabolic factors, particularly excess body weight and elevated cholesterol, were the main drivers of risk, while an independent urban effect and pronounced north–south regional differences highlight the need for targeted weight and lipid management and intensified long-term risk control, especially in cities and high-prevalence northern regions.