Unmasking the contemporary burden of hypertension in Lagos, Nigeria: insights from an opportunistic screening

Abstract

Hypertension remains the leading modifiable risk factor for global morbidity and mortality, disproportionately affecting low- and middle-income countries (LMICs). In Nigeria, prevalence and control rates remain poor, yet contemporary city-level data are limited. To determine the prevalence, awareness, treatment, and control of hypertension among adults screened during a community-based blood pressure screening campaign in Lagos, Nigeria, in 2023. We conducted a cross-sectional opportunistic screening of adults aged ≥18 years across hospitals, pharmacies, workplaces, and public spaces in Lagos, Nigeria. Sociodemographic data, medical history, and lifestyle factors were obtained using a study proforma adapted from the WHO STEPS questionnaire as relevant to our study proforma. Blood pressure (BP) was measured three times with an OMRON M7 Intelli IT device; the mean of the readings defined BP status. Hypertension was classified as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or self-reported use of antihypertensive medication. Descriptive statistics, chi-square tests, and logistic regression analyses were used to identify predictors of blood pressure status. A total of 1,547 individuals were screened (median age 47 years, IQR 38–57; 51.2% female). Overall hypertension prevalence was 52.5%, comprising 34.7% previously diagnosed and 17.8% newly detected cases. Among hypertensives, 39.9% reported treatment use, and 60.2% of those on medication achieved BP control. Awareness of hypertension was low (34.7%), with significant age and sex disparities: prevalence increased with age, and men were more frequently affected than women (p=0.015). Logistic regression identified age, male sex, higher BMI, low education, and prior diagnosis as significant predictors of elevated BP. Opportunistic community-based screening in 2023 revealed a high burden of undiagnosed hypertension and suboptimal awareness in Lagos, Nigeria. These findings underscore the need for sustained mass screening, improved access to affordable antihypertensive therapy, and health system strategies to close the care cascade gap. These findings provide novel, contemporary evidence of hypertension burden and care gaps in Lagos, Nigeria, complementing national estimates and offering insights relevant to urban health strategies in low- and middle-income countries.