Abstract Body: Background: Hypertension, a potent risk factor for cardiovascular disease, is increasingly prevalent in sub-Saharan Africa. Identifying intervention targets requires an examination of hypertension management. This study analyzed the hypertension care cascade—prevalence, awareness, treatment, and control—to identify management gaps in adults >25 years in south-central Uganda.

Methods: Data from the Rakai Community Cohort Study, a longitudinal, open, population-based cohort from 34 communities in south-central Uganda, were used. Hypertension was defined as systolic BP >140 mmHg, diastolic BP >90 mmHg, or current use of anti-hypertensive medication. A care cascade was constructed to describe hypertension prevalence, awareness, treatment, and control, stratified by age (25-49 and >50 years) and HIV serostatus. Modified Poisson regression was used to assess factors associated with hypertension and cascade levels by estimating adjusted prevalence ratios (aPR).

Results: Among 10,132 adults aged 25-49 years and 1,647 adults >50 years, hypertension prevalence was 13% and 36%, respectively. Of participants with hypertension aged 25-49, 23% were aware of their diagnosis, 9% were receiving treatment, and 4% had controlled hypertension. Men aged 25-49 with hypertension had a 1% control rate. Among those >50 years, the cascade rates were 44%, 27%, and 12%, respectively. Adjusted analyses showed that factors associated with higher prevalent hypertension included older age [aPR 1.62 (1.57–1.68)], male sex [aPR 1.13 (1.02–1.24)], obesity [aPR 2.01 (1.79-2.26)], moderate to heavy alcohol consumption [aPR 1.37 (1.24–1.52)], and living in a trading community [aPR 1.16 (1.06–1.27)]. Older age and higher BMI were also linked to higher rates of diagnosis awareness, treatment, and BP control. Male sex, however, was associated with lower attainment of all care cascade levels. Persons with HIV were more likely to be on treatment [aPR 1.39 (1.07–1.80)] and controlled [aPR 1.65 (1.12–2.42)]. Conversely, new study participants were less likely to be aware of their hypertension [aPR 0.74 (0.59–0.91)] and on treatment [aPR 0.61 (0.42–0.91)].

Conclusions: These findings reveal that hypertension is prevalent in this population, with substantial gaps throughout the care cascade, particularly among men. Urgent improvements in diagnosis, treatment, and control are needed. Cost-effective interventions and integrated care models are essential to improve hypertension management in this region.