The Hypertension Care Cascade in Bangladesh: A Nationally Representative Analysis of BDHS 2022

Hypertension is a leading modifiable cause of cardiovascular mortality globally. Up-to-date nationally representative evidence on the full hypertension care cascade (prevalence, awareness, treatment, and blood pressure control) and on the determinants of each stage remains limited for Bangladesh. This study estimated the burden of hypertension and identified determinants of each cascade stage to inform equity-sensitive policy. We analysed data from 13,760 adults aged ≥ 18 years in the biomarker subsample of the Bangladesh Demographic and Health Survey 2022 (BDHS 2022), a nationally representative cross-sectional survey. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current antihypertensive medication use. The care cascade was constructed sequentially across four stages: prevalence, awareness, treatment, and blood pressure control among treated adults. All analyses incorporated complex survey design features. Survey-weighted multivariable logistic regression identified independent determinants of each cascade stage, adjusting for age, sex, education, body mass index, diabetes, wealth quintile, place of residence, and administrative division. Sensitivity analyses used a measured-blood-pressure-only definition, a missing-indicator approach for missing covariate data, and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) thresholds (≥ 130/80 mmHg). The weighted prevalence of hypertension was 20.7% (95% CI: 19.8–21.7). Among hypertensive adults, 54.8% (95% CI: 52.5–57.2) were aware of their diagnosis and 45.1% (95% CI: 42.6–47.6) were on treatment; 43.6% (95% CI: 40.5–46.8) of those treated, equivalent to 19.7% of all hypertensive adults, had controlled blood pressure. Advanced age was the strongest correlate of hypertension (adjusted odds ratio [AOR] for age ≥ 65 vs. 18–34 years: 15.59; 95% CI: 12.77–19.04). Female sex (AOR: 1.64; 95% CI: 1.47–1.85), overweight (AOR: 2.05; 95% CI: 1.81–2.33), obesity (AOR: 3.57; 95% CI: 3.03–4.20), diabetes (AOR: 1.34; 95% CI: 1.17–1.53), and belonging to the richer (AOR: 1.24; 95% CI: 1.03–1.49) and richest (AOR: 1.34; 95% CI: 1.09–1.66) wealth quintiles were independently associated with hypertension. Awareness and treatment were higher among women, older adults, adults with diabetes or obesity, those with secondary education, and those in the richest wealth quintile; treatment was also higher among adults with higher education and in the richer quintile. Higher education was the only factor independently associated with blood pressure control among treated adults (AOR: 2.09; 95% CI: 1.27–3.43; control: 35.8% with no education vs. 59.4% with higher education). Associations with age, sex, and body mass index were robust in sensitivity analyses, whereas those with diabetes and wealth were attenuated when hypertension was defined by measured blood pressure alone. Hypertension affects about one in five Bangladeshi adults, and losses occur at every stage of the care cascade, so that only one in five hypertensive adults has controlled blood pressure. Strengthening community-based screening, ensuring continuous access to affordable antihypertensive medicines, and integrating patient education and follow-up into primary care may help to close these gaps, particularly for men, younger adults, and people with limited education.