Abstract
Hypertension, defined as persistently elevated blood pressure, is the most prevalent noncommunicable disease worldwide, which affects approximately 1.4 billion adults between the ages of 30 and 79, accounting for 33%. Being asymptomatic, 44% of individuals are unaware of hypertension, 44% are diagnosed and treated, and only 23% achieve adequate blood pressure control. In the Democratic Republic of Congo (DRC), the prevalence of hypertension is estimated at 34%. Among them, 40% are diagnosed, 26% are on treatment, and only 12% are optimally managed. Beyond genetic and environmental factors, hypertension is largely driven by lifestyle-related behavioural risk factors, including smoking, alcohol abuse, harmful dietary practices and sedentary life. Notably, the WHO STEPwise NCD surveillance had not been implemented in the DRC since 2005, and no published studies have examined lifestyle and health-seeking behaviour related to hypertension in Kolwezi.
To address this gap, a cross-sectional survey was carried out in Kolwezi, DRC, utilising the WHO STEPwise tool. The prevalence rates of lifestyle factors were as follows: tobacco use, 7.7%; alcohol abuse, 48.5%; and fruit intake categorised as none, low, moderate and high at 4.9%, 41%, 18% and 36.1%, respectively. Physical activity undertaken at fitness facilities, at the workplace, or during transportation (walking or cycling) were reported by 18.2%, 47.5% and 70.7%, respectively. Health-seeking behaviour was observed in 69.7%, while the overall prevalence of hypertension was 29.1%, which was slightly lower than national (34%) and global estimates (33%). Unemployment, inability to work, and formal self-employment were negatively associated with hypertension, acting as protective factors (OR=0.74; 95% CI: 0.59-0.93; p=0.009) and (OR=0.86; 95% CI: 0.75-0.99; p=0.035), respectively. Dietary factors, including moderate and high vegetable intake, emerged as predictors of hypertension (OR=1.29; 95% CI: 1.06-1.75; p=0.013) and (OR=1.51; 95% CI: 1.23-1.66; p<0.001), respectively. Salt intake control was also a predictor of hypertension (OR=1.11; 95% CI: 1.02-1.20; p=0.018). These paradoxical findings likely reflect the limitations of cross-sectional, self-reported data and the phenomenon of reverse causality, rather than true causal relationships and require further studies in low-resource African setting.