Undiagnosed hypertension and its determinants among adults in Rwanda in the 2021–2022 WHO STEPS survey

Abstract

Abstract Hypertension remains a major public health concern in Rwanda, yet many affected adults remain undiagnosed. This study examined the extent and determinants of undiagnosed hypertension using data from the nationally representative 2021–2022 Rwanda STEPS Survey. A total of 1,223 adults aged 18–69 years who met clinical criteria for hypertension were included in this cross-sectional analysis. Survey-adjusted multivariable binary logistic regression was used to identify factors associated with being undiagnosed. Overall, 42.9% (95% CI: 39.1–46.9; n   =  524 ) of hypertensive adults were unaware of their condition. Younger adults were significantly more likely to be undiagnosed, particularly those aged 18–24 years (AOR = 2.9, 95% CI: 1.30–6.30, p  = 0.009) and 25–34 years (AOR = 1.9, 95% CI: 1.11–3.20, p  = 0.020). Men had more than double the odds of being undiagnosed compared with women (AOR = 2.7, 95% CI: 1.82–3.96, p  < 0.001). Higher education was protective, while residents of the Western Province showed elevated odds (AOR = 1.8, 95% CI: 1.07–3.05, p  = 0.026). Not visiting a health worker in the past year was the strongest predictor of remaining undiagnosed (AOR = 3.2, 95% CI: 2.33–4.51, p  < 0.001). These findings highlight the need to expand routine blood pressure screening to younger adults and men, and to strengthen community-based detection efforts across Rwanda.