Abstract
Abstract Background Hypertension is a major public health concern in Bangladesh and a leading contributor to cardiovascular disease. To address this, the Bangladesh Hypertension Control Initiative (BHCI) was launched in 2018 in Sylhet district, expanded to Sylhet division in 2021, and further extended to other divisions in 2023. The initiative aims to improve hypertension detection, treatment, and control by strengthening primary healthcare services through the NCD corners. Purpose This study aims to assess community level hypertension control rate in Bangladesh by comparing data from BDHS 2017-18 and BDHS 2022. It examines changes in hypertension control rates over time and evaluates sociodemographic variations to identify disparities in hypertension control. Methods This secondary analysis used data from BDHS 2017–18 and BDHS 2022, two nationally representative cross-sectional surveys. Both datasets included adults aged ≥18 years, with sample sizes of 13,131 in BDHS 2017–18 and 14,296 in BDHS 2022. Blood pressure was measured using a standardized digital monitor, and hypertension was defined as systolic BP ≥140 mmHg, and/or diastolic BP ≥90 mmHg, or current antihypertensive use. Community control rate of hypertension was defined as the proportion of hypertensive individuals on antihypertensive treatment who had controlled blood pressure (<140/90 mmHg). Weighted adjusted marginal prevalence of community control rate was estimated across sociodemographic groups using multivariable logistic regression, accounting for the complex survey design. Results For BDHS 2017–18, 27.5% of adults were hypertensive, with 42.4% aware, 37.0% treated, and 12.5% controlled (14.9% urban, 11.5% rural). By BDHS 2022, hypertension prevalence declined to 20.5% (95% CI: 19.6–21.4), while awareness, treatment, and control rates increased to 54.3% (95% CI: 52.0–56.6), 44.6% (95% CI: 42.1–47.0), and 19.3% (95% CI: 17.5–21.1), respectively (22.6% urban, 17.9% rural). The adjusted community control rate in BDHS 2017–18 was higher among adults aged 45–59 years (14.5%, 95% CI: 12.3–16.6), females (15.2%, 95% CI: 13.5–17.0), individuals with higher education (14.6%, 95% CI: 10.7–18.6), and residents of Sylhet (18.3%, 95% CI: 13.6–23.0). By BDHS 2022, community control improved, with higher rates among older adults (60+ years: 23.6%, 95% CI: 20.3–26.8), individuals with higher education (30.7%, 95% CI: 24.8–36.7), and residents of Sylhet (30.2%, 95% CI: 23.4–36.9). Conclusion Between BDHS 2017–18 and BDHS 2022, hypertension prevalence declined, while community control rates improved. However, disparities persist, with lower control rates in rural areas and socioeconomically disadvantaged groups. The BHCI has likely contributed to the substantial improvement in hypertension control observed in the Sylhet region. These findings highlight the effectiveness of structured, community-based hypertension management programs in improving blood pressure control.