Discussion

The present community-based study demonstrated that hypertension affected 38.6% of adults residing in rural Gwalior, while an additional 29.4% were classified as pre-hypertensive. Consequently, more than two-thirds of the study population either had hypertension or were at increased risk of developing it. These findings emphasize the considerable burden of hypertension in rural communities and reflect the ongoing epidemiological transition toward non-communicable diseases in India.

The prevalence observed in the present study is broadly consistent with findings from other regions of the country. The Puducherry STEPS survey reported a hypertension prevalence of 33.6% [14], whereas national estimates have ranged between 22.6% and 28.1% [15,16]. Higher prevalence has been documented among older adults, reaching 41.9% in individuals aged 45 years and above [4]. Conversely, some rural studies have reported lower prevalence estimates of approximately 21.4% [15]. The comparatively higher prevalence identified in the present study may reflect ongoing demographic and lifestyle changes, including increasing obesity, dietary modifications, and reduced physical activity. Similar upward trends in hypertension prevalence and systolic blood pressure have also been documented in longitudinal studies from rural North India [17].

Advancing age was significantly associated with higher blood pressure categories in the study population. Participants in older age groups exhibited greater proportions of stage 1 and stage 2 hypertension, consistent with previous evidence demonstrating a progressive increase in hypertension prevalence with advancing age. National data indicate that nearly half of adults aged 60 years or older are hypertensive [15], while comparable observations have also been reported among tribal populations [18]. These findings are consistent with the cumulative effects of vascular ageing and prolonged exposure to cardiovascular risk factors.

Male participants exhibited a greater burden of hypertension than female participants, with significantly higher proportions of stage 1 and stage 2 hypertension. Similar sex-related differences have been reported in several community-based studies and national surveys [15,19]. The higher prevalence among men may be associated with their greater exposure to behavioral risk factors, including tobacco use and alcohol consumption, both of which are recognized contributors to elevated blood pressure [10].

Measures of both generalized and central obesity showed a strong association with hypertension. More than half of the participants were either overweight or obese, while a substantial proportion had increased waist circumference and waist-to-hip ratio. These findings are consistent with national evidence demonstrating that excess body weight and abdominal adiposity are associated with hypertension [15]. The Longitudinal Ageing Study in India (LASI) also reported marked socioeconomic differences in central obesity [14]. Compared with earlier rural studies in which undernutrition predominated, the present findings suggest a transition toward obesity-related cardiovascular risk factors.

Dietary practices also appeared to be associated with blood pressure status. Nearly three-fifths of participants reported consuming additional dietary salt, which showed a significant association with hypertension. Excess sodium intake has consistently been identified as an important modifiable factor associated with hypertension and cardiovascular disease [15]. Furthermore, the high frequency of junk food consumption observed in this study reflects changing dietary patterns in rural communities, which may further contribute to the increasing burden of non-communicable diseases [14].

Behavioral risk factors were common in the study population. Approximately one-third of participants reported smoking, alcohol consumption, or smokeless tobacco use, and both smoking and alcohol intake were significantly associated with hypertension. These observations are consistent with evidence from South Asian populations demonstrating that unhealthy lifestyle behaviors are associated with increased cardiovascular risk [20]. The coexistence of multiple behavioral risk factors may further increase susceptibility to hypertension, particularly among vulnerable groups [10].

A positive family history was significantly associated with hypertension, suggesting that genetic susceptibility together with shared environmental and behavioral factors may influence blood pressure. Similar associations have been documented in national studies evaluating risk factors for hypertension [16].

The findings also highlight persistent challenges in hypertension control. A considerable proportion of individuals with hypertension remain unaware of their condition or do not receive adequate treatment, resulting in poor blood pressure control [21]. These challenges are particularly pronounced in rural settings, where barriers such as limited healthcare access, inadequate awareness, and poor treatment adherence continue to affect disease management [17]. Consequently, rural populations experience disproportionately higher cardiovascular morbidity and mortality than their urban counterparts [20].

Community-based interventions have demonstrated considerable potential for improving hypertension prevention and management. Evidence from an accredited social health activist (ASHA)-led program has shown meaningful improvements in blood pressure control among rural populations [22]. Strengthening such initiatives may improve hypertension prevention and management in rural communities.

Strengths

The present study has several strengths. It employed a community-based cross-sectional design with an adequate sample size and a multistage sampling technique. Standardized procedures were used for measuring blood pressure and anthropometric parameters. In addition, the study assessed a range of sociodemographic, behavioral, dietary, anthropometric, and family history-related factors associated with hypertension. The findings provide district-level data on the prevalence of hypertension and its associated factors among adults residing in rural Gwalior.

Limitations

The findings of this study should be interpreted in light of several limitations. First, the cross-sectional study design precludes establishing temporal or causal relationships between hypertension and the associated factors. Second, the study was conducted in selected rural areas of Gwalior district, which may limit the generalizability of the findings to other geographic regions or urban populations. Third, several lifestyle-related variables, including dietary salt intake, physical activity, smoking, alcohol consumption, and sleep patterns, were based on self-reported information and may therefore be subject to recall and social desirability bias. Fourth, blood pressure measurements were obtained during a single visit, making it possible that transient fluctuations or the white-coat effect influenced classification. Fifth, although multistage sampling was employed, selection bias cannot be completely excluded because participants were recruited from selected households. Sixth, only bivariate (chi-square) analysis was performed; therefore, potential confounding factors were not adjusted for, and independent associations could not be established. Finally, the absence of biochemical investigations and detailed dietary assessments limited a more comprehensive evaluation of metabolic and nutritional determinants of hypertension. Nevertheless, the study provides valuable district-level evidence regarding the burden of hypertension and its associated factors and offers useful information for planning targeted public health interventions in rural communities.