Cardiovascular

Prevalence, associations and sex-related disparities of hypertension in South Asians: Evidence from a national survey of Sri Lanka.

Mettananda C, Premaratna R, et al. • PloS one • 2026

PubMed 42970550 DOI 10.1371/journal.pone.0361894
TL;DR

More than half of hypertensives in this South Asian population were previously undiagnosed; about three-quarters of diagnosed hypertensives were treated but only about one-third achieved BP targets, and while prevalence, treatment and control did not differ by sex, undiagnosed hypertension was more common in men.

Key Findings

Results

About 37% of Sri Lankan adults had hypertension in the 2021 national STEPS survey.

  • Analysis of secondary data from the Sri Lanka STEPS Survey 2021, a nationally representative, community-based, cross-sectional study.
  • 4,634 adults were analysed (mean age 43.5 years, weighted CI 43.0-44.1; female 54.8%, 53.1-56.5).
  • Hypertension was defined as BP ≥140/90 mmHg or current antihypertensive use; overall prevalence was 37.2% (35.5-38.9).
Results

A majority of hypertensive adults were previously undiagnosed.

  • 60.0% (58.1-63.4) of those with hypertension had not been previously diagnosed.
  • The authors conclude that more than half of hypertensives in this South Asian population were previously undiagnosed.
Results

Among previously diagnosed hypertensives, most were on treatment but only a minority achieved BP targets.

  • 73.6% (69.6-77.2) of those previously diagnosed were on treatment.
  • Only 38.0% (33.0-44.2) achieved BP targets (controlled BP defined as <140/90 mmHg).
  • The authors summarise this as about three-quarters treated but only one-third at goal.
Results

Hypertension prevalence, treatment rates and BP control did not differ significantly between females and males.

  • Prevalence of hypertension: p = 0.600.
  • Treated hypertension: p = 0.398.
  • Controlled blood pressure: p = 0.819.
Results

Undiagnosed hypertension was significantly more common in males than in females.

  • Undiagnosed hypertension was 69.4% (65.3-73.1) in males versus 53.6% (50.1-57.0) in females (p < 0.001).
  • The authors conclude that detection should be improved, especially in men.
Results

The factors associated with hypertension differed by sex.

  • Diabetes was associated with hypertension only in females (p < 0.001).
  • Wealth quintile was associated with hypertension only in males (p < 0.001).
  • 24-hour urinary salt excretion was associated with hypertension only in males (p = 0.011).
  • Associations were assessed using logistic regression with sex-stratified analyses.
Results

Overweight/obesity was associated with undiagnosed hypertension only in males in stratified analyses.

  • The association in males had p = 0.017.
  • No significant association was reported in females in stratified analyses.

What This Means

This study used a nationwide 2021 health survey of 4,634 adults in Sri Lanka to look at how common high blood pressure is, how many people know they have it, and how well it is treated. About 37% of adults had hypertension. Of these, six in ten had never been told they had it. Among people who knew they had high blood pressure, about three-quarters were taking treatment, but only about 38% had their blood pressure under control. Overall rates of high blood pressure, treatment and control were similar in women and men. However, men were much more likely to be undiagnosed (about 69% versus 54% of women). Different factors were linked to high blood pressure in each sex: diabetes in women, and household wealth and salt intake in men. Overweight or obesity was linked to undiagnosed hypertension only in men. This research suggests that better detection of high blood pressure, especially in men, and better treatment to reach target levels in both sexes could help improve blood pressure control in Sri Lanka. Because the study is a cross-sectional survey, it shows associations at one point in time and cannot prove cause and effect.

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Citation

Mettananda C, Premaratna R, Mallawa R, Fernando U, Senaratne A, Perera U, et al.. (2026). Prevalence, associations and sex-related disparities of hypertension in South Asians: Evidence from a national survey of Sri Lanka.. PloS one. https://doi.org/10.1371/journal.pone.0361894