Empirical Study of Hypertension Cascade of Care and Treatment Gaps in Rural Nasarawa State

The hypertension cascade of care, from awareness through treatment to control, has been identified as a useful framework for understanding the structured treatment gap that explains why high hypertension prevalence does not translate to clinical control across sub-Saharan African rural settings. This study empirically characterised the hypertension cascade of care in rural communities in Nasarawa State, North Central Nigeria. A community-based cross-sectional analytical study was conducted in Akwanga, Awe, and Nasarawa Eggon LGAs, enrolling 480 adults aged 35 years and above through multistage cluster sampling. Blood pressure was measured following WHO protocol, and hypertension was defined per current guidelines. Cascading outcomes were assessed: prevalence, awareness (self-reported prior diagnosis), treatment (current antihypertensive medication use), and control (blood pressure below 140/90 mmHg among those treated). Predictors at each cascade step were modelled using logistic regression. Results showed hypertension prevalence of 35.4 percent. Awareness among hypertensives was 51.8 percent; treatment among those aware was 73.0 percent; and control among those treated was only 38.4 percent. Significant predictors of awareness included female gender, older age, and prior facility contact. Predictors of treatment included health literacy and distance to PHC below 5 km. Predictors of control included regular antihypertensive medication refills and dietary modification adherence. The study provides the first cascade analysis for rural Nasarawa State, identifying awareness and control as the two most critical cascade gaps requiring targeted intervention.

Keywords: hypertension cascade, treatment gap, rural communities, Nasarawa State, blood pressure control