Untreated, uncontrolled and below-target hypertension in southern Africa: a population-based prevalence and care cascade assessment in rural Lesotho

INTRODUCTION: Hypertension programmes have expanded substantially in low-income and middle-income countries, yet treatment and control rates remain insufficient. Programme scale-up may lead to suboptimal health outcomes and resource allocation if diagnostic accuracy, monitoring and treatment protocol adherence are inadequate. This study aimed to estimate the prevalence of untreated, uncontrolled and below-target hypertension in rural Lesotho, and to identify factors associated with each condition. METHODS: We conducted a population-based cross-sectional study nested within the Community-Based Chronic Care Lesotho (ComBaCaL) cohort study (NCT05596773). Adult cohort participants ≥18 years were eligible for home-based standardised blood pressure (BP) measurement. Hypertension was defined by averaged elevated BP measurements or current use of antihypertensive medication. Uncontrolled hypertension was defined as on-treatment BP ≥140/90 mm Hg, and below-target hypertension as on-treatment systolic BP