Project – Prevalence and Factors Associated with Hypertension Among Adults: A Case Study of Selected Communities in Lagos State.

CHAPTER ONE

INTRODUCTION

Research Topic: Prevalence and Factors Associated with Hypertension Among Adults: A Case Study of Selected Communities in Lagos State

1.1 Background to the Study

Hypertension, commonly known as high blood pressure, is a major public health concern because it increases the risk of cardiovascular diseases, stroke, kidney disease, and premature death. It is a chronic condition in which the pressure of blood against the walls of the arteries remains persistently elevated, placing additional strain on the heart and blood vessels. The condition is particularly important in public health because it may develop without obvious symptoms, allowing affected individuals to remain undiagnosed for long periods. The World Health Organization (WHO, 2023) identifies hypertension as a leading cause of premature death worldwide and emphasises that early detection, appropriate treatment, and sustained blood pressure control can reduce its complications. Similarly, the Global Burden of Disease study reported that elevated systolic blood pressure is a major contributor to the global burden of disease and mortality (GBD 2019 Risk Factors Collaborators, 2020). These findings show that hypertension is not merely an individual medical problem but a wider public health issue requiring prevention, screening, treatment, and community-based health education. Investigating its prevalence and associated factors among adults is therefore important for identifying populations at risk and supporting effective interventions.

The global burden of hypertension has increased in response to demographic changes, population ageing, urbanisation, and shifts in lifestyle and dietary practices. Many adults now live in environments characterised by reduced physical activity, greater availability of energy-dense foods, high salt consumption, and increased exposure to behavioural and social factors associated with cardiovascular risk. Although hypertension can be managed through lifestyle modification and appropriate medication, many affected individuals are unaware of their condition or do not achieve adequate blood pressure control. NCD Risk Factor Collaboration (NCD-RisC, 2021), in a comprehensive analysis of worldwide trends in hypertension prevalence, detection, treatment, and control, documented substantial international disparities in the management of the condition. The WHO (2023) likewise emphasises that a considerable proportion of people with hypertension remain undiagnosed or inadequately treated. These global patterns demonstrate the importance of investigating not only how many adults have hypertension but also the demographic, behavioural, and environmental factors associated with the condition. Such information can guide preventive programmes and improve the early identification of adults who may require medical evaluation.

In sub-Saharan Africa, hypertension has become an increasingly important public health challenge due to population growth, urbanisation, changing dietary habits, and persistent difficulties in accessing preventive and long-term healthcare. The burden is particularly concerning because hypertension can remain undetected until complications such as stroke, heart failure, or kidney damage occur. At the same time, the capacity to provide routine screening, continuous treatment, and long-term monitoring varies across communities and healthcare settings. Ataklte et al. (2015), in a systematic review and meta-analysis of hypertension among sub-Saharan African adults, documented a substantial burden of the condition and highlighted gaps in awareness, treatment, and control. Similarly, Sarki et al. (2015), in a systematic review and meta-analysis of hypertension in sub-Saharan Africa, found that the condition was common across the region, although prevalence estimates varied between populations and studies. This evidence indicates that hypertension requires context-specific investigation because differences in age distribution, lifestyle, socioeconomic circumstances, health service access, and measurement procedures may influence reported prevalence. Examining hypertension in selected communities in Lagos State can therefore contribute locally relevant information to the broader effort to reduce cardiovascular disease in Nigeria and sub-Saharan Africa.

In Nigeria, hypertension is an important non-communicable disease that affects adults across different demographic and socioeconomic groups. Its public health significance is reflected in the growing number of affected individuals and the continuing challenges associated with awareness, treatment, and control. Adeloye et al. (2021), in a systematic analysis of Nigerian evidence, estimated that the age-adjusted prevalence of hypertension among adults aged 20 years and above increased from 8.6% in 1995 to 32.5% in 2020. The authors also found that awareness, treatment, and blood pressure control remained inadequate, indicating that a substantial number of affected adults were not receiving effective management. In a nationwide survey based on the WHO STEPwise approach, Odili et al. (2020) reported an age-standardised hypertension prevalence of 38.1% among Nigerian adults, with variation across geopolitical zones and age groups. Differences between these estimates reflect the populations, periods, and methods used in the respective studies; they should not be interpreted as a single fixed national rate. Nevertheless, both studies demonstrate that hypertension represents a significant health burden in Nigeria and support the need for local studies that can identify prevalence patterns and associated factors in particular communities.

Lagos State is an important setting for studying hypertension because it is highly urbanised and contains communities with diverse demographic characteristics, occupations, income levels, dietary practices, and access to healthcare. Urban living can create opportunities for improved access to hospitals, pharmacies, health information, and screening services, but it may also be associated with sedentary occupations, motorised transportation, time constraints, high consumption of processed foods, and other lifestyle patterns that can increase cardiovascular risk. The relationship between urbanisation and hypertension is not uniform, however, and should be assessed alongside individual and community characteristics. Odili et al. (2020) found that hypertension was common in both urban and rural Nigerian populations, suggesting that the burden is not restricted to one type of settlement. Adeloye et al. (2021) also demonstrated the importance of examining regional and population-level patterns when interpreting hypertension estimates in Nigeria. Consequently, the study of selected communities in Lagos State is relevant because it can provide evidence about the local distribution of hypertension and the circumstances associated with it, rather than assuming that findings from national studies fully describe every community.

Several demographic, behavioural, and socioeconomic factors have been associated with hypertension among adults. Age is an important factor because blood vessels may become less elastic as people grow older, contributing to increased blood pressure. Other potential factors include family history of hypertension, excess body weight, high dietary salt intake, inadequate physical activity, harmful alcohol consumption, tobacco use, unhealthy dietary patterns, and certain underlying health conditions. Socioeconomic factors, including educational attainment, occupation, income, and access to healthcare, may also influence lifestyle choices, opportunities for screening, and the management of diagnosed hypertension. The WHO (2023) identifies modifiable risk factors such as unhealthy diets, physical inactivity, tobacco use, and harmful alcohol consumption as important targets for hypertension prevention. The GBD 2019 Risk Factors Collaborators (2020) likewise identified elevated blood pressure as a major contributor to disease burden and emphasised the importance of addressing cardiovascular risk factors. Investigating these factors among adults in selected Lagos communities may help determine which characteristics are associated with hypertension in the study population and provide a basis for designing appropriate health education and prevention programmes.

Despite increased awareness of hypertension as a public health problem, important challenges remain in identifying affected adults, ensuring that people know their blood pressure status, and promoting sustained management. Because hypertension often produces no noticeable symptoms, adults may not seek screening unless they experience illness or visit a health facility for another reason. Some individuals may also face barriers such as the cost of healthcare, limited time, inadequate health information, or difficulty maintaining long-term treatment. Evidence from Nigeria indicates that awareness and control remain inadequate despite the high prevalence of the condition (Adeloye et al., 2021; Odili et al., 2020). More recent evidence from an opportunistic screening campaign in Lagos, based on adults screened in 2023, also reported a high proportion of participants with hypertension, including previously undiagnosed cases, while identifying age, sex, body mass index, and educational level among the factors associated with blood pressure status (Unmasking the contemporary burden of hypertension in Lagos, Nigeria: Insights from an opportunistic screening, 2026). Because opportunistic screening participants may not represent all adults living in Lagos, these findings cannot be treated as the definitive prevalence for every community. They nevertheless reinforce the need for locally grounded investigation. Against this background, the present study examines the prevalence of hypertension and factors associated with it among adults in selected communities in Lagos State, with the aim of generating evidence that may support early detection, health education, and community-level prevention.

1.2 Statement of the Problem

Hypertension has become a significant public health concern because it is associated with cardiovascular complications, stroke, kidney disease, and premature mortality. A major difficulty in controlling the condition is that many affected adults do not experience obvious symptoms and may therefore remain unaware of their blood pressure status until complications develop. Evidence from Nigeria demonstrates that hypertension is widespread and that awareness, treatment, and control remain important challenges. Adeloye et al. (2021) estimated that the age-adjusted prevalence of hypertension among Nigerian adults aged 20 years and above reached 32.5% in 2020, while Odili et al. (2020) reported an age-standardised prevalence of 38.1% in a nationwide survey. These estimates were derived from different evidence and study methods, but both demonstrate the substantial burden of hypertension in Nigeria. The problem is therefore not only the number of adults affected but also the possibility that many people in local communities remain undiagnosed or inadequately managed. This situation makes it necessary to investigate the prevalence of hypertension among adults in selected communities in Lagos State.

Another problem concerns the factors that may contribute to the occurrence of hypertension among adults in Lagos State. Age, family history, excess body weight, dietary habits, physical inactivity, alcohol consumption, and other behavioural and socioeconomic characteristics may be associated with elevated blood pressure. However, the importance of these factors may differ among communities because residents have different demographic profiles, occupations, living conditions, dietary practices, and access to healthcare. The WHO (2023) identifies unhealthy diets, physical inactivity, tobacco use, and harmful alcohol consumption among the important modifiable risk factors for hypertension. Similarly, the GBD 2019 Risk Factors Collaborators (2020) identify elevated blood pressure as a major contributor to global disease burden. Although these findings establish the importance of recognised risk factors, they do not automatically establish which factors are most strongly associated with hypertension among adults in the particular communities selected for this study. Consequently, a community-based investigation is necessary to assess the distribution of hypertension and examine its association with relevant demographic, socioeconomic, and lifestyle characteristics.

The challenge is particularly relevant in Lagos State, where urbanisation, population density, occupational demands, and changing patterns of food consumption and physical activity may influence cardiovascular health. Although healthcare facilities and screening opportunities are available in parts of Lagos, access to screening and knowledge of personal blood pressure status may differ across communities. A recent study by Amadi et al. (2026), based on opportunistic screening conducted in Lagos in 2023, reported a high burden of hypertension among the adults screened, including previously undiagnosed cases. The authors also identified age, sex, body mass index, and educational level among characteristics associated with blood pressure status. However, the study used opportunistic rather than population-representative sampling, meaning that its findings should not be treated as the definitive prevalence for all adults or communities in Lagos State. This limitation highlights the importance of further community-specific research that clearly identifies its study population and methods. Without such evidence, it may be difficult to determine whether findings from selected screening populations adequately reflect the experiences and risk patterns of adults in the communities under investigation.

The central problem addressed by this study is the need for reliable, community-specific evidence on the prevalence of hypertension and the factors associated with the condition among adults in selected communities in Lagos State. Although national studies and recent Lagos screening research have established that hypertension is a substantial public health concern, local differences in population characteristics, lifestyle, and access to healthcare mean that findings cannot automatically be generalised to every community. The absence of adequate information about the selected communities may limit the ability of health workers and public health planners to identify adults at increased risk and develop appropriately targeted screening and health education programmes. Adeloye et al. (2021) emphasise the importance of improving hypertension awareness, treatment, and control in Nigeria, while Amadi et al. (2026) highlight continuing gaps in detection and management in Lagos. Accordingly, this study will determine the prevalence of hypertension among adults in selected communities in Lagos State and examine the demographic, socioeconomic, and lifestyle factors associated with the condition. The findings may provide useful evidence for community-level prevention, early detection, and public health planning.

1.3 Aim and Objectives of the Study

The main aim of this study is to determine the prevalence and factors associated with hypertension among adults in selected communities in Lagos State.

The specific objectives are to:

1. Determine the prevalence of hypertension among adults in selected communities in Lagos State.

2. Examine the relationship between selected sociodemographic characteristics, such as age, sex, educational level, and occupation, and hypertension among adults in the study communities.

3. Assess the association between lifestyle factors, including dietary habits, physical activity, alcohol consumption, and body mass index, and hypertension among adults in the selected communities.

4. Examine the association between family history of hypertension, awareness of blood pressure status, and access to healthcare services and hypertension among adults in the selected communities.

1.4 Research Questions

The following research questions will guide the study:

1. What is the prevalence of hypertension among adults in selected communities in Lagos State?

2. What relationship exists between selected sociodemographic characteristics and hypertension among adults in the study communities?

3. How are lifestyle factors associated with hypertension among adults in the selected communities?

4. What association exists between family history of hypertension, awareness of blood pressure status, access to healthcare services, and hypertension among adults in the selected communities?

1.5 Research Hypothesis

The following null hypothesis will be tested:

H₀: There is no statistically significant association between selected sociodemographic and lifestyle factors and hypertension among adults in the selected communities in Lagos State.

1.6 Significance of the Study

The findings of this study are expected to be useful to public health authorities, healthcare professionals, adults living in the selected communities, community leaders, policymakers, researchers, and students.

Public health authorities: The study may provide information on the prevalence of hypertension and the factors associated with it in the selected communities. Such information could support the planning of community-based screening, health education, and cardiovascular disease prevention programmes.

Healthcare professionals: The findings may assist healthcare workers in identifying characteristics associated with hypertension among adults in the study population. The information could support health promotion, risk assessment, referral for medical evaluation, and appropriate follow-up.

Adults in the selected communities: The study may improve awareness of hypertension, its possible risk factors, and the importance of checking blood pressure even when symptoms are absent. It may also encourage healthier dietary habits, regular physical activity, and timely use of healthcare services.

Community leaders and organisations: The results may help community leaders, religious organisations, civil society groups, and local health advocates support blood pressure screening campaigns and disseminate appropriate health information.

Government and policymakers: The findings may contribute to evidence-based planning for hypertension prevention and control in Lagos State. They may also help identify areas where access to screening and health information could be strengthened.

Researchers and students: The study may contribute to existing literature on hypertension in Nigeria and provide a basis for further research on its prevalence, risk factors, awareness, treatment, and control in other communities.

1.7 Scope of the Study

The study focuses on the prevalence and factors associated with hypertension among adults in selected communities in Lagos State, Nigeria.

The geographical scope is restricted to the communities selected by the researcher within Lagos State. The names of the communities should be specified in the final research proposal or methodology.

The population scope comprises adults aged 18 years and above who meet the study’s inclusion criteria and reside in the selected communities.

The content scope covers the prevalence of hypertension and its association with selected sociodemographic characteristics, lifestyle factors, family history, awareness of blood pressure status, and access to healthcare services.

For the purpose of measurement, the study should state the diagnostic definition of hypertension adopted in its methodology. Where the WHO (2021) and relevant clinical guidance are followed, hypertension in adults is generally classified as systolic blood pressure of at least 140 mmHg and/or diastolic blood pressure of at least 90 mmHg. Blood pressure assessment should follow a consistent measurement procedure, and the study should explain how repeat measurements, previous diagnosis, and current antihypertensive medication use will be considered when classifying participants.

1.8 Limitations of the Study

The study may encounter limitations relating to the availability of participants, access to selected communities, financial resources, and the time required for data collection. These factors may influence the number of adults who can be recruited and the geographical coverage of the study.

Another possible limitation is the accuracy of self-reported information concerning dietary habits, alcohol consumption, physical activity, family history, and previous diagnosis of hypertension. Participants may not remember their health history accurately or may provide responses they consider socially acceptable. Standardised questions and clear explanations may help reduce these problems.

Blood pressure measurements may also vary because of temporary stress, recent physical activity, measurement conditions, or differences in technique. The researcher should therefore use appropriate equipment, trained data collectors where applicable, and a consistent measurement protocol. Where the study uses a cross-sectional design, the findings will identify associations rather than establish that particular factors caused hypertension.

Finally, findings from selected communities may not represent every adult in Lagos State. The study will acknowledge this limitation and restrict its conclusions to the population and setting covered by the research.

1.9 Operational Definition of Terms

Hypertension: A condition characterised by persistently elevated blood pressure. In this study, its classification will follow the diagnostic criteria specified in the methodology.

Prevalence: The proportion of adults in the selected communities who meet the study’s criteria for hypertension at the time of assessment.

Adults: Individuals aged 18 years and above who meet the eligibility requirements for participation in the study.

Associated Factors: Demographic, socioeconomic, behavioural, medical, and healthcare-related characteristics that show a statistical relationship with hypertension in the study population.

Lifestyle Factors: Behavioural characteristics such as dietary habits, physical activity, alcohol consumption, and tobacco use that may be associated with blood pressure and cardiovascular health.

Sociodemographic Characteristics: Personal and social characteristics such as age, sex, educational attainment, occupation, marital status, and income category.

Body Mass Index (BMI): A measure calculated by dividing a person’s weight in kilograms by the square of their height in metres. It is used to classify weight status according to established criteria.

Family History of Hypertension: A reported history of hypertension among close biological relatives of a participant.

Blood Pressure Screening: The measurement of blood pressure to identify individuals whose readings may indicate elevated blood pressure and who may require further assessment.

Awareness of Hypertension: Knowledge of one’s hypertension status, particularly whether a healthcare professional has previously diagnosed the condition.

Selected Communities: The specific communities within Lagos State chosen by the researcher as the geographical setting for the study.

1.10 Organisation of the Study

The study is organised into five chapters.

Chapter One presents the introduction, background to the study, statement of the problem, aim and objectives, research questions, research hypothesis, significance, scope, limitations, operational definitions, and organisation of the study.

Chapter Two reviews relevant literature on hypertension, including its definition, prevalence, associated factors, theoretical perspectives, empirical findings, and gaps in existing research.

Chapter Three describes the research methodology, including the research design, study area, population, sample size, sampling technique, data collection instruments, validity and reliability procedures where applicable, data collection process, ethical considerations, and methods of data analysis.

Chapter Four presents the results, analyses the data, and discusses the findings in relation to the research questions, hypothesis, and relevant literature.

Chapter Five summarises the findings, draws conclusions, provides recommendations, discusses the implications of the study, and suggests areas for further research.

Project – Prevalence and Factors Associated with Hypertension Among Adults: A Case Study of Selected Communities in Lagos State.