Undiagnosed and Uncontrolled Hypertension in the Aseer Region, Saudi Arabia: A Ramadan Screening Study with Long-Term Trends (1990-2019) and Projections to 2027.

BACKGROUND

Community-based screening initiatives can facilitate early detection and link individuals to care. This study aimed to assess the prevalence of diagnosed and undiagnosed hypertension among adults in the Aseer region during Ramadan and contextualize these findings within national hypertension trends using World Health Organization (WHO) data from 1990 to 2019, with projections to 2027.

METHODS

A cross-sectional study was conducted from March 11-18, 2025, including 657 adults. Participants were classified as non-hypertensive, previously diagnosed, or having undiagnosed hypertension. Multinomial logistic regression was used to identify factors associated with hypertension status. Secondary analysis of WHO data was performed to examine national trends in hypertension prevalence and projection using autoregressive integrated moving average (ARIMA) and Poisson regression models.

RESULTS

Primary data revealed that 56.3% had undiagnosed hypertension (stage 1: 43.8% and stage 2: 56.2%) and 16.6% had a prior diagnosis (stage 1: 27.5% and stage 2: 62.4%). Older age (adjusted odds ratio (aOR): 17.17, 95% CI 4.80-61.42 for ages 55-64), male sex (aOR: 2.24, 95% CI 1.16-4.33), higher body mass index (aOR: 1.10, 95% CI 1.05-1.15), diabetes (aOR: 2.23, 95% CI 1.14-4.37), and self-reported dyslipidemia (aOR: 3.52, 95% CI 1.72-7.24) were independent predictors of diagnosed hypertension. Male sex and higher BMI were also significant predictors of undiagnosed hypertension. Between 1990-2019, secondary data revealed that females showed a significant decline in the prevalence of hypertension from 34.1% (95% CI: 21.5-49.2) to 30.2% (95% CI: 21.4-40.1) (APC: -0.58%), while prevalence among males increased from 34.4% (95% CI: 21.5-49.1) to 36.3% (95% CI: 26.6-46.7) (APC: 0.18%). Overall prevalence decreased slightly from 34.4% (95% CI: 24.9-45.1) to 34.0% (95% CI: 27.1-41.5) (APC: -0.4%). Forecasts for 2027 predicted a continued decline among females to 27.47% (95% prediction interval (PI): 26.42-28.51) (APC: -2.73%) and a modest increase among males to 36.82% (95%PI: 36.55-37.09) (APC: 1.4%), with the total prevalence projected to decrease slightly to 33.39% (95%PI: 32.64-34.14) (APC: -1.01%).

CONCLUSION

Ramadan-based screening revealed a high burden of undiagnosed and uncontrolled hypertension. Along with forecasts of rising male but falling female prevalence, this underscores the urgent need for targeted community-based screening, education, and management to improve hypertension awareness and control.