What This Means
This research suggests that in South Kivu Province in eastern Democratic Republic of the Congo, people living in rural areas actually have higher rates of high blood pressure (hypertension) than those living in cities, which is the opposite of patterns historically seen in many parts of the world. Among over 4,000 adults surveyed during health screening campaigns in 2023 and 2024, about 1 in 3 rural residents had hypertension compared to roughly 1 in 4 urban residents. Even after accounting for differences in age, weight, smoking, diabetes, and exercise habits, living in a rural area was still associated with a 55% higher likelihood of having hypertension.
Interestingly, the urban and rural populations differed in which cardiovascular risk factors they carried. Urban residents were more likely to be overweight, obese, physically inactive, and have diabetes — the risk factors typically associated with hypertension. Rural residents, however, were older on average and smoked more. The fact that rural residence independently predicted hypertension even after adjusting for these factors suggests that other elements of the rural environment — possibly including limited access to healthcare and low rates of hypertension diagnosis and treatment — play an important role.
This research matters because it challenges the assumption that rural populations in low-income countries are protected from hypertension. It suggests that as unhealthy behaviors spread into rural areas and populations age, the burden of cardiovascular disease in these underserved communities may be substantial and underdetected. The authors call for improved hypertension screening programs and health education campaigns specifically targeted at rural populations in the DRC and similar settings.