Hypertension Among Medical Students in Lubumbashi, Democratic Republic of the Congo: Prevalence, Associated Factors and Comparison of the 2025 ACC/AHA and JNC 7 Classifications.

BACKGROUND

Hypertension is increasingly recognised among young adults, but its estimated prevalence varies substantially according to the diagnostic criteria used. This study assessed the prevalence and factors associated with hypertension among medical students in Lubumbashi, Democratic Republic of the Congo (DRC), using the 2025 American College of Cardiology/American Heart Association (ACC/AHA) criteria, and compared the findings with the JNC 7 classification.

METHODS

We conducted a cross-sectional study among students aged ≥ 18 years at the Faculty of Medicine, University of Lubumbashi, from July to August 2023. Blood pressure and anthropometric measurements were obtained using standardised procedures, and sociodemographic, behavioural and family-history data were collected using a structured questionnaire. Hypertension was defined according to the 2025 ACC/AHA criteria and, for sensitivity analysis, according to JNC 7. Factors associated with hypertension were assessed using logistic regression, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs). The agreement between the two classifications was assessed using Cohen's κ and McNemar's test.

RESULTS

Among 3505 medical students, 1171 (33.4%) were classified as hypertensive according to the 2025 ACC/AHA criteria. In multivariable analysis, hypertension was independently associated with a family history of hypertension (aOR 1.31, 95% CI 1.09-1.59), higher BMI (aOR 1.02 per kg/m2, 95% CI 1.00-1.04), alcohol consumption (aOR 1.32, 95% CI 1.09-1.62) and physical inactivity (aOR 1.22, 95% CI 1.02-1.46). Using JNC 7, only 168 students (4.8%) were classified as hypertensive. In the sensitivity analysis, older age, higher academic level and a family history of hypertension were associated with JNC 7-defined hypertension. The agreement between the two classifications was 71.4% (κ = 0.18, p < 0.001), while McNemar's test indicated a significant difference in paired classifications (χ 2 = 1003.0, p < 0.001).

CONCLUSION

Hypertension was highly prevalent among medical students when classified according to the 2025 ACC/AHA criteria, although the prevalence was substantially lower using JNC 7. The limited agreement between the two classifications highlights the considerable impact of diagnostic thresholds on the estimated burden of hypertension among young adults. Early identification of modifiable and familial factors may support targeted cardiovascular risk prevention in university populations.