Hypertension Control in Bangladesh: Changes, Sociodemographic Variation, and Socioeconomic Inequality from the 2017–18 to 2022 Bangladesh Demographic and Health Surveys

Abstract

Background. Hypertension is a major public health challenge in Bangladesh, yet population-level blood pressure control remains poorly characterized. This study estimated changes in population-level hypertension control between the Bangladesh Demographic and Health Survey (BDHS) 2017-18 and BDHS 2022 and examined sociodemographic variation and socioeconomic inequality in hypertension control.

Methods. Nationally representative BDHS 2017–18 (n = 13,131) and BDHS 2022 (n = 14,296) data were analyzed using a cross-sectional design. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or antihypertensive medication use. Population-level control was defined as blood pressure <140/90 mmHg among hypertensive individuals in the population. Adjusted control rates and sociodemographic variation were estimated using pooled survey-weighted multivariable logistic regression with marginal standardization. Socioeconomic inequality was assessed using the concentration index (CnI), slope index of inequality (SII), and relative index of inequality (RII).

Findings. Among individuals with hypertension, control increased from 12.5% (95% CI: 11.3-13.8) in 2017-18 to 19.3% (17.5-21.2) in 2022, alongside increases in awareness from 42.4% (40.5-44.4) to 54.3% (51.9-56.6) and treatment from 37.0% (35.2-38.9) to 44.6% (42.1-47.0). Hypertension prevalence was 27.5% (26.5-28.5) in 2017-18 and 20.5% (19.6-21.4) in 2022. Adjusted control improved across most sociodemographic groups, with the largest increases among older adults (+6.5%), females (+6.3%), urban residents (+6.8%), individuals with higher education (+7.3%), and residents of Sylhet (+7.9%) and Chattogram (+7.2%) divisions. Socioeconomic inequality also increased between 2017-18 and 2022, with a persistent pro-rich pattern (CnI: 0.11 to 0.13; SII: 8.5% to 15.1%; RII: 1.99 to 2.22).

Conclusion. Population-level hypertension control in Bangladesh improved between survey rounds, although socioeconomic and geographic disparities persisted. Differences in survey implementation and measurement methods warrant cautious interpretation of changes over time. Strengthening equitable primary care and medication access may help sustain improvements and reduce disparities.