Association of blood pressure control, lifestyle and socioeconomic status with self-rated health in patients with hypertension: a national cross-sectional study.

OBJECTIVES

To examine demographic, behavioural and clinical determinants of self-rated health (SRH) among Iranian adults with hypertension (HTN), with a particular focus on the association between blood pressure (BP) control and perceived health.

DESIGN

National cross-sectional analysis of 15 predictors spanning demographic, lifestyle and clinical domains.

SETTING

2021 Iranian STEPwise Approach to Non-communicable Disease Risk Factor Surveillance, a nationally representative survey.

PARTICIPANTS

A total of 8812 adults with HTN (mean age 56.97 years; 57% female). Controlled HTN was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg among individuals on antihypertensive therapy.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was SRH, measured on a standard EuroQol-Visual Analogue Scale (0-100).

RESULTS

Controlled HTN was independently associated with higher SRH scores (β=1.31, 95% CI 0.07 to 2.54). Positive predictors of SRH included male gender (β=4.34, 95% CI 3.38 to 5.31), higher wealth (richest vs poorest: β=5.52, 95% CI 4.06 to 6.97), sufficient physical activity (β=4.38, 95% CI 3.48 to 5.28), healthier diet (β=3.06, 95% CI 1.99 to 4.14) and complementary insurance coverage (β=2.50, 95% CI 0.63 to 4.37). Significant negative predictors included diabetes mellitus (β=-4.23, 95% CI -5.59 to -3.26), dyslipidaemia (β=-3.61, 95% CI -4.62 to -2.59), people who smoke (β=-4.21, 95% CI -5.64 to -2.78) and older age. Notably, antihypertensive medication use showed one of the strongest negative associations with SRH (monotherapy: β=-4.83; combination therapy: β=-5.28), likely reflecting underlying disease severity and treatment burden.

CONCLUSIONS

Better SRH among hypertensive adults was associated with controlled BP, healthier lifestyle patterns and higher socioeconomic status. Conversely, comorbidities, smoking, older age and antihypertensive treatment were linked to poorer perceived health. Integrating SRH screening into HTN management may help identify vulnerable individuals and inform targeted interventions addressing behavioural and socioeconomic determinants of health.