Introduction

Hypertension is one of the leading non-communicable diseases worldwide and remains a major contributor to cardiovascular morbidity and mortality. Because it often progresses without noticeable symptoms until complications develop, it is commonly referred to as the "silent killer." Uncontrolled hypertension substantially increases the risk of stroke, myocardial infarction, heart failure, and chronic kidney disease. The rising prevalence of hypertension has been driven by population aging, rapid urbanization, demographic transition, and widespread lifestyle changes, particularly in low- and middle-income countries such as India [1]. Owing to its high disease burden and preventable nature, effective prevention and control of hypertension are important public health priorities.

India has witnessed a steady increase in the prevalence of hypertension over recent decades. National surveys estimate that approximately one in four adults is affected, although prevalence varies by age, geographic location, and socioeconomic status [2]. Among individuals aged 15-49 years, hypertension affects about 11.3% of the population, with a slightly lower prevalence reported in rural areas (10.6%) [3]. In contrast, the prevalence increases markedly to approximately 41.9% among adults aged 45 years and older [4]. Furthermore, a systematic review estimated a pooled prevalence of 27.6% in rural India, indicating that hypertension is no longer confined to urban populations and has become an important public health concern across diverse settings [5].

Hypertension prevalence varies considerably across regions of India. A community-based study in rural Bihar found a prevalence of 24.55%, with another 25.35% classified as pre-hypertensive [6]. Similarly, studies in rural Maharashtra and rural Delhi reported rates of 29.99% and 14.1%, respectively [7,8]. These regional differences likely reflect variations in population characteristics, diet, lifestyle, socioeconomic conditions, and healthcare access. This highlights the need for district-level epidemiological studies to provide locally relevant evidence for planning effective prevention and control strategies.

Hypertension develops from a complex interaction of non-modifiable and modifiable risk factors. Advancing age, sex, and hereditary predisposition are key non-modifiable determinants. Modifiable risk factors include excess dietary salt, overweight and obesity, physical inactivity, tobacco use, alcohol consumption, and metabolic abnormalities. Studies consistently identify increasing age, higher body mass index (BMI), tobacco and alcohol use, and excessive salt intake as significant predictors of hypertension in rural populations [3,6,9]. Additionally, educational attainment, occupation, and socioeconomic status may affect both exposure to these risk factors and access to healthcare services [2].

Many individuals with hypertension in India remain undiagnosed, untreated, or inadequately controlled, especially in rural areas. Studies report low awareness, treatment, and blood pressure control among socioeconomically disadvantaged groups [4,10]. Delayed diagnosis often results from poor health literacy, limited screening, restricted healthcare access, and poor treatment adherence [10]. As a result, many continue to suffer preventable cardiovascular complications despite effective interventions.

Although several national and regional studies have described the epidemiology of hypertension, district-specific data from central India remain limited. Gwalior district is undergoing demographic and lifestyle transitions that may influence both the prevalence of hypertension and its associated risk factors. Reliable local evidence is essential for designing targeted interventions, strengthening primary healthcare services, and supporting the implementation of community-based non-communicable disease control programs. However, published data on the prevalence of hypertension and its associated risk factors among adults residing in the rural areas of Gwalior district are scarce.

Therefore, the present study was undertaken to estimate the prevalence of hypertension and assess its association with selected sociodemographic, anthropometric, behavioral, dietary, and family history-related factors among adults residing in rural Gwalior. The findings are expected to provide district-level evidence to support early detection, lifestyle modification, and the planning of effective community-based hypertension prevention and control strategies.