Translate this page into:
Prevalence and factors associated with hypertension among pensioners in three districts of Kigali City, Rwanda, 2023: A cross-sectional study
*Corresponding author: Pierre Ndikumwenayo, Department of Epidemiology and Biostatistics, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda. ndagiwekephas@gmail.com
-
Received: ,
Accepted: ,
How to cite this article: Ndikumwenayo P, Judith M, Ndagijimana A. Prevalence and factors associated with hypertension among pensioners in three districts of Kigali City, Rwanda, 2023: A cross-sectional study. Indian J Med Sci. 2026;78:103-12. doi: 10.25259/IJMS_313_2025
Abstract
Objectives:
This study aimed to determine the prevalence of hypertension and identify associated factors among pensioners in three districts of Kigali City, Rwanda.
Materials and Methods:
We conducted a cross-sectional survey among 220 pensioners aged ≥60 years in three districts of Kigali City between July 5 and August 20, 2023. Data on sociodemographic characteristics, medical history (including HIV and diabetes), behavioral factors, anthropometry, and occupational stress were collected using a structured questionnaire, and blood pressure was measured. Hypertension was defined as the use of antihypertensive medication or an average systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Bivariate and multivariable logistic regression analyses were used to identify factors associated with hypertension, with results presented as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Data were analyzed using STATA version 15.1, with statistical significance set at p < 0.05.
Results:
Among the 220 participants, 53.2% had hypertension, with a higher proportion among men (65.8%). HIV-positive participants had significantly higher odds of hypertension (AOR: 18.41, 95% CI: 3.23–104.93) compared to HIV-negative individuals. Participants with diabetes mellitus had higher odds of hypertension (AOR: 16.87, 95% CI: 1.59–178.84) compared to those without diabetes. Participants reporting occasional work-related stress had increased odds of hypertension (AOR: 2.90, 95% CI: 1.20–7.02). Frequent work-related stress was also associated with higher odds of hypertension (AOR: 13.51, 95% CI: 2.21–82.83).
Conclusion:
This study found a high prevalence of hypertension among urban pensioners in Kigali City, with HIV infection, diabetes mellitus, and occupational stress identified as associated factors. These findings highlight the need for targeted interventions, including HIV prevention, stress management, promotion of physical activity, and healthy lifestyle practices.
Keywords
Associated factors
Hypertension
Pensioners
Prevalence
INTRODUCTION
By 2025, developing countries are projected to host 75% of the global hypertensive population, with an estimated economic burden of 370 billion USD, and accounting for nearly 10% of global healthcare expenditures.[1] Hypertension often leads to chronic illness, disability, and premature death, contributing to increased economic burden on affected households.
According to the 2021 Fidelity retiree health care cost estimate, an average retired couple aged 65 years may require up to 300,000 USD for healthcare expenses during retirement.[2,3] Socioeconomic transitions, including unemployment, rapid urbanization, and population aging, have been linked to increased rates of hypertension and cardiovascular diseases, with retirement and job loss identified as associated factors.[4,5] In sub-Saharan Africa, rural-to-urban migration and limited attention to noncommunicable diseases (NCDs) have accelerated the hypertension epidemic, with prevalence rates exceeding those reported in many high-income countries.[6]
Despite its growing impact, global health funding for NCDs, including hypertension, remains disproportionately low, accounting for <3% of total health aid, which limits prevention and control efforts in developing regions.[7] The World Health Organization reports that NCD-related mortality in developing countries is higher among adults aged over 60 years than among younger populations.[8]
Studies estimate that approximately 60% of Africans aged ≥60 years are hypertensive, with prevalence rates of 65% in men and 75% in women.[9] In Rwanda, the 2022 NCDs risk factors report reported a hypertension prevalence of 43.2% among adults aged 60–69 years, compared to 16.8% in the general adult population (18–69 years), with higher prevalence among females.[10] Similar findings have been reported globally, with hypertension prevalence among older adults reaching 68% in Mexico[11] and 71% in Argentina.[12] By 2030, the number of people living with hypertension in Africa is projected to exceed 216 million.[13]
Hypertension is influenced by multiple factors, including age, sex, socioeconomic status, psychosocial stress, family history, dietary habits, tobacco and alcohol use, physical inactivity, and body weight.[1] Evidence from studies in Malawi and Ethiopia revealed inconsistent gender associations with hypertension prevalence,[14-16] while research elsewhere has demonstrated significant variation by education level and population group.[17-21] In Rwanda, approximately 46% of adults are hypertensive, accounting for an estimated 730 deaths annually.[22] Among adults aged 15–64 years, the national prevalence is 15.9%, with higher rates among older individuals.[23] Despite national initiatives in Rwanda to address hypertension, including expanded health insurance coverage,[24] limited evidence exists on the prevalence and associated factors among pensioners.
This study aimed to determine the prevalence of hypertension and identify associated factors among pensioners in three districts of Kigali City, Rwanda.
MATERIALS AND METHODS
This study employed a cross-sectional design, where exposure and outcome variables were measured simultaneously. Therefore, temporal relationships between risk factors and hypertension could not be established.
Occupational stress was assessed retrospectively based on participants’ past work experiences, while hypertension was measured at the time of the survey. The study aimed to determine the prevalence of hypertension and its associated factors. Kigali City comprises three districts, 35 sectors, 161 cells, and 1,155 villages. Data were collected between July and August 2023 from pensioners aged ≥60 years or older residing in Kigali City. The study population included retired men and women receiving pension benefits from public or private institutions.
Eligible participants were aged ≥60 years and permanent residents of Kigali City. Individuals aged <60 years, those aged 60–65 still employed, foreign nationals, and persons unable to provide reliable information due to physical or mental conditions were excluded. A total of 220 pensioners were included in the study. The sample size was calculated based on a hypertension prevalence of 43.2% among adults aged 60–69 years, as reported in the 2021–2022 Rwanda NCDs risk factors study.[10] A multistage sampling technique was used to ensure representation across all districts. Sectors, cells, and villages were randomly selected within each district.
Pensioners were identified using lists from the Rwanda social security board (RSSB) and the Rwandese association of retired. These lists included names, ages, addresses, and contact details for participant identification and follow-up. Eligible participants were contacted by phone, informed about the study, and invited to participate. Those who agreed provided written and verbal consent before data collection. The final sample included participants from 21 sectors, 37 cells, and 45 villages across the three districts. Participants were selected proportionally from each district based on the pensioner population size to enhance representativeness.
Data collection instruments, procedures, and quality control
Data were collected using a structured interviewer-administered questionnaire, complemented by physical and biochemical measurements. Standardized digital scales were used to measure weight and height, and validated sphygmomanometers were used to measure blood pressure. Blood pressure was measured twice, one minute apart, and the average value was recorded. Participants unable to attend measurement sessions were referred to nearby health centers, where trained professionals measured blood pressure using standard procedures. Information on blood glucose levels and HIV status was obtained from medical records or verified reports from health facilities. The questionnaire collected sociodemographic, behavioral, and medical information and was administered in English and Kinyarwanda. Data were collected electronically using Kobo Toolbox. Participant confidentiality and data security were maintained throughout the study. All field staff were trained on standardized measurement techniques and ethical data handling procedures.
Data processing, study variables, and analysis
Hypertension was defined as self-reported use of antihypertensive medication or an average systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Socio-demographic variables included age, sex, education level, occupation, marital status, residence, health insurance type, and household wealth index. Clinical variables included HIV status and diabetes mellitus. Behavioral factors included tobacco use, alcohol consumption, physical inactivity, body mass index (BMI), and fruit and vegetable intake.
Occupational stress was assessed retrospectively using self-reported information on participants’ past work experiences. Participants were asked how often they experienced work-related stress during their working life, with responses categorized as “never,” “occasional,” or “frequent.” These categories defined levels of occupational stress. A validated occupational stress scale was not used, and responses were based on subjective recall. HIV status was obtained from self-report and available medical records. Diabetes status was based on self-reported diagnosis and/or use of antidiabetic medication, supported by medical records when available. No direct blood glucose or glycated hemoglobin measurements were performed.
BMI analyses were conducted using complete-case analysis, including only participants with available anthropometric data. Data were entered and cleaned before analysis. Descriptive statistics (frequencies and percentages) were used to summarize participant characteristics. Bivariate logistic regression was used to assess associations between independent variables and hypertension. Variables with p < 0.05 in bivariate analysis were included in the multivariable logistic regression model. Age, sex, and BMI were included in the multivariable model as established confounders, regardless of statistical significance. Model stability was assessed based on the number of hypertension events per variable.
Ethical consideration
The study received ethical approval from the Institutional Review Board of the University of Rwanda, College of Medicine and Health Sciences (Reference No. CMHS/IRB/278/2023). Additional clearance was obtained from the Rwanda National Ethics Committee (RNEC; FWA Assurance No. 00001973/IRB/00001497). Written authorization to access pensioners’ records and conduct field activities was granted by the RSSB (Reference No. RSSB/5019/hr/23) and the City of Kigali (Reference No. 1328/07.01.16/23).
All participants were fully informed about the purpose and procedures of the study, and written informed consent was obtained before data collection. Confidentiality was maintained throughout the study, and all collected information was stored securely and used solely for research purposes in accordance with ethical research principles.
RESULTS
Description of socio-demographic and co-morbidities characteristics of participants
A total of 220 pensioners participated in the study, comprising 64.5% men and 35.5% women. Nearly half of the respondents (44%) resided in Nyarugenge District. Most of the participants (63.6%) had attained secondary education, and the majority (88.2%) were legally married. Pensioners who had worked in local and central government institutions represented the largest occupational group (46.8%). Regarding comorbid conditions, 9.1% of respondents reported being HIV-positive, while 7.3% had been diagnosed with diabetes mellitus. Details of participants’ sociodemographic and clinical characteristics are presented in Table 1.
| Variable | Frequency (n=220) | Percentage |
|---|---|---|
| Names of residence | ||
| Gasabo | 61 | 27.73 |
| Kicukiro | 62 | 28.18 |
| Nyarugenge | 97 | 44.09 |
| Gender | ||
| Male | 142 | 64.55 |
| Female | 78 | 35.45 |
| Age (years) | ||
| 62–70 | 114 | 51.82 |
| 71–83 | 106 | 48.18 |
| Health insurance | ||
| RAMA and MMI | 176 | 80 |
| CBHI | 44 | 20 |
| Educational level | ||
| Primary or less | 16 | 7.27 |
| Secondary | 140 | 63.64 |
| Tertiary | 64 | 29.09 |
| Occupation | ||
| Health services | 31 | 14.09 |
| Local and central government | 103 | 46.82 |
| Teaching | 61 | 27.73 |
| Others | 25 | 11.36 |
| Marital status | ||
| Current married | 194 | 88.18 |
| Divorced/widowed | 26 | 11.82 |
| Pensioners salaried per month/wealth index | ||
| <100,000 | 44 | 20 |
| 100000 and above | 176 | 80 |
| Diabetes Mellitus | ||
| Normal | 204 | 92.73 |
| High glucose | 16 | 7.27 |
| HIV/AIDS | ||
| Positive | 20 | 9.09 |
| Negative | 200 | 90.91 |
HIV: Human immunodeficiency virus, AIDS: Acquired immunodeficiency syndrome, RAMA: Rwandaise d’assurance maladie, MMI: Military medical insurance, CBHI: Community-based health insurance
Pensioners’ behavioral characteristics and occupational stress-related factors
More than half of the participants (56.4%) reported a history of tobacco use, and 12.4% were current smokers at the time of the survey. A large proportion (83.6%) indicated previous alcohol consumption. Among the 146 participants with available anthropometric measurements, 66.4% (n = 97) had a BMI ≥ 25 kg/m2, while 33.6% (n = 49) had a normal BMI (18.5–24.9 kg/m2). Anthropometric data were available for 146 participants out of the total 220 study participants. The missing BMI data were mainly due to logistical constraints during data collection, including lack of calibrated equipment at some data collection sites, participants’ physical limitations that prevented accurate measurement, and refusal or unavailability of some participants at the time of measurement. Regarding occupational stress, 15% of the respondents reported having worked under stressful conditions, whereas 85% had not. In terms of workplace stress frequency, 58.2% experienced stress occasionally, 14.6% experienced it frequently, and 27.3% reported never experiencing workplace stress. Details are presented in Table 2.
| Variables | Frequency (n=220) |
Percentage | |
|---|---|---|---|
| Body mass index status | |||
| Normal | 49 | 33.64 | |
| Abnormal | 97 | 66.36 | |
| History of tobacco consummation | |||
| Yes | 124 | 56.36 | |
| No | 96 | 43.64 | |
| Current smoker | |||
| Yes | 27 | 12.39 | |
| No | 193 | 87.73 | |
| History of alcohol drunk | |||
| Yes | 184 | 83.64 | |
| No | 36 | 16.36 | |
| Current drunker | |||
| Yes | 83 | 37.73 | |
| No | 137 | 62.27 | |
| Number of days ate fruits per week | |||
| 0–2 days | 91 | 41.36 | |
| 3–5 days | 112 | 50.91 | |
| 6–7 days | 17 | 7.73 | |
| Number of days ate vegetables per week | |||
| 0–2 days | 9 | 4.09 | |
| 3–5 days | 139 | 63.18 | |
| 6–7 days | 72 | 32.73 | |
| Physical activity | |||
| Yes | 52 | 23.64 | |
| No | 168 | 76 | |
| Ever worked in stressful condition | |||
| Yes | 33 | 15 | |
| No | 187 | 85 | |
| Ever had stress at work | |||
| Sometimes | 128 | 58.18 | |
| Several times | 32 | 14.55 | |
| Never | 60 | 27.27 | |
Prevalence of hypertension among participants
The overall prevalence of hypertension among the study participants was 53.2%. The mean systolic and diastolic blood pressure values were 139.8 mmHg and 89.4 mmHg, respectively. Among male pensioners, the mean blood pressure was 140.1/89.9 mmHg, while among females it was 139.3/88.6 mmHg. These findings indicate a high burden of hypertension within the pensioner population in Kigali City. Details of the blood pressure distribution are presented in Figure 1.
Factors associated with hypertension
Bivariate analysis: The socio-demographic and comorbidities factors associated with hypertension
Bivariate analysis revealed several sociodemographic and comorbidity factors significantly associated with hypertension among pensioners in Kigali City. Participants residing in Kicukiro District had 2.4 times higher odds of developing hypertension compared with those from Gasabo District (Crude odds ratio [COR] = 2.44, 95% confidence interval [CI]: 1.18–5.04). Pensioners enrolled in the community-based health insurance scheme had 57.6% lower odds of hypertension (COR = 0.42, 95% CI: 0.21–0.84) compared with those covered by rwandaise d’assurance maladie (RAMA) or military medical insurance (MMI). Individuals with a BMI ≥25 kg/m2 had nearly twice the odds of hypertension compared with those with normal BMI (COR = 1.99, 95% CI: 1.13–3.51, p=0.018).
Pensioners who had been employed in central or local government institutions had threefold higher odds of hypertension compared with those who had worked in health services (COR = 3.10, 95% CI: 1.35–7.09, p= 0.007). In addition, respondents living with HIV/AIDS were almost nine times more likely to have hypertension (COR = 9.47, 95% CI: 2.14–41.94, p= 0.003), while those with elevated blood glucose levels had 15-fold higher odds compared with non-diabetic participants (COR = 15.00, 95% CI: 1.95–115.67, p= 0.009). These associations are summarized in Table 3.
| Variables | HTN n (%) | Non-HTN n (%) | OR | 95% CI | p-value |
|---|---|---|---|---|---|
| Gender | |||||
| Male | 77 (65.81) | 65 (63.11) | (Ref) | ||
| Female | 40 (34.19) | 38 (36.89) | 0.88 | 0.510–1.545 | 0.676 |
| Residences | |||||
| Gasabo | 25 (21.37) | 36 (34.95) | (Ref) | ||
| Kicukiro | 39 (33.33) | 23 (22.33) | 2.282 | 1.107–4.704 | 0.025 |
| Nyarugenge | 53 (45.30) | 44 (42.72) | 1.555 | 0.815–2.966 | 0.180 |
| Health insurance | |||||
| RAMA and MMI | 101 (86.32) | 75 (72.82) | (Ref) | ||
| CBHI | 16 (13.68) | 28 (27.18) | 0.424 | 0.214–0.840 | 0.014 |
| Age (years) | |||||
| 62–70 | 59 (50.43) | 55 (53.40) | (Ref) | ||
| 71–83 | 58 (49.57) | 48 (46.60) | 1.126 | 0.662–1.914 | 0.660 |
| Level of education | |||||
| Primary | 8 (6.84) | 8 (7.77) | (Ref) | ||
| Secondary | 70 (59.83) | 70 (67.96) | 1 | 0.355–2.813 | 1.000 |
| Tertiary | 39 (33.33) | 25 (24.27) | 1.56 | 0.518–4.691 | 0.429 |
| Occupation | |||||
| Health services | 14 (11.97) | 17 (16.50) | ( Ref) | ||
| Local and central government | 74 (63.25) | 29 (28.16) | 3.098 | 1.354–7.088 | 0.007 |
| Teaching | 18 (15.38) | 43 (41.75) | 0.508 | 0.207–1.245 | 0.139 |
| Others | 11 (9.40) | 14 (13.59) | 0.954 | 0.330–2.754 | 0.931 |
| Marital status | |||||
| Current married | 103 (88.03) | 91 (88.35) | (Ref) | ||
| Divorced/Widowed | 14 (11.97) | 12 (11.65) | 1.030 | 0.453–2.342 | 0.942 |
| Pensioners salaries/wealth index | |||||
| <100,000 | 18 (15.38) | 26 (25.24) | (Ref) | ||
| 100000 and above | 99 (84.62) | 77 (74.76) | 1.857 | 0.949–3.631 | 0.230 |
| BMI status | |||||
| Normal | 31 (26.50) | 43 (41.75) | (Ref) | ||
| Abnormal | 86 (73.50) | 60 (58.25) | 1.988 | 1.127–3.506 | 0.018 |
| HIV/AIDS | |||||
| Negative | 95 (84.07) | 100 (98.04) | (Ref) | ||
| Positive | 18 (15.93) | 2 (1.96) | 9.473 | 2.140–41.935 | 0.003 |
| DM | |||||
| Normal | 102 (87.18) | 102 (99.03) | (Ref) | ||
| High glucose | 15 (12.82) | 1 (0.97) | 15 | 1.945–115.67 | 0.009 |
HTN: Hypertension, DM: Diabetes mellitus, CI: Confidence interval, OR: Odds ratio, RAMA: Rwandaise d’assurance maladie, MMI: Military medical insurance, CBHI: Community-based health insurance, BMI: Body mass index, HIV: Human immunodeficiency virus, AIDS: Acquired immunodeficiency syndrome. Statistical significance was considered at p < 0.05.
Bivariate analysis: Behaviors and occupation-related stress factors with hypertension
Behavioral and occupational stress factors were also significantly associated with hypertension. Pensioners who used tobacco products had more than twice the odds of having hypertension compared with non-users (COR = 2.29, 95% CI: 1.33–3.95, p= 0.003). Similarly, those who consumed alcohol had 2.7 times higher odds of hypertension than non-drinkers (COR = 2.66, 95% CI: 1.25–5.64, p= 0.011).
Participants who had previously worked under stressful conditions had markedly higher odds of hypertension (COR = 11.49, 95% CI: 3.39–38.97, p=<0.001) compared with those who reported less stressful work environments. Among those who experienced occupational stress, individuals reporting occasional stress had nearly fourfold higher odds of hypertension (COR = 3.86, 95% CI: 1.95–7.62, p=<0.001), while those who experienced frequent stress at work had substantially higher odds (COR = 45.00, 95% CI: 9.59– 211.17, p=<0.001) compared with participants who reported no workplace stress. Details are presented in Table 4.
| Variables | HTN n(%) | Non-HTN n(%) | OR | 95% CI | p-value |
|---|---|---|---|---|---|
| History of tobacco consumption | |||||
| No | 40 (34.19) | 56 (54.37) | (Ref) | ||
| Yes | 77 (65.81) | 47 (45.63) | 2.293 | 1.330–3.952 | 0.003 |
| Current smoker | |||||
| No | 98 (83.76) | 93 (92.08) | (Ref) | ||
| Yes | 19 (16.24) | 8 (7.92) | 2.253 | 0.941–5.398 | 0.068 |
| History of alcohol drunker | |||||
| No | 12 (10.26) | 24 (23.30) | (Ref) | ||
| Yes | 105 (89.74) | 79 (76.70) | 2.658 | 1.253–5.638 | 0.011 |
| Current alcohol drunker | |||||
| No | 68 (58.12) | 69 (66.99) | (Ref) | ||
| Yes | 49 (41.88) | 34 (33.01) | 1.462 | 0.842–2.537 | 0.176 |
| Number of days ate vegetables per week | |||||
| 6–7 days | 6 (5.13) | 11 (10.68) | (Ref) | ||
| 0–2 days | 54 (46.15) | 37 (35.92) | 2.675 | 0.909–7.871 | 0.074 |
| 3–5 days | 57 (48.72) | 55 (53.40) | 1.9 | 0.657–5.492 | 0.236 |
| Number of vegetable servings per days | |||||
| Twice or 3 times | 2 (1.71) | 1 (0.97) | (Ref) | ||
| Never or once. | 115 (98.29) | 102 (99.03) | 0.563 | 0.050–6.309 | 0.642 |
| Number of days ate fruits per week | |||||
| 6–7 days | 6 (5.13) | 11 (10.68) | (Ref) | ||
| 0–2 days | 54 (46.15) | 37 (35.92) | 2.675 | 0.909–7.871 | 0.074 |
| 3–5 days | 57 (48.72) | 55 (53.40) | 1.9 | 0.657–5.492 | 0.236 |
| Number of fruits servings per days | |||||
| Never or once | 115 (98.29) | 102 (99.03) | |||
| Twice or 3 times | 2 (1.71) | 1 (0.97) | 1.77 | 0.158–19.853 | 0.642 |
| Physical activity | |||||
| No | 91 (77.78) | 77 (74.76) | (Ref) | ||
| Yes | 26 (22.22) | 26 (25.24) | 0.0.936 | 0.502–1.744 | 0.835 |
| Ever worked in stressful condition | |||||
| No | 87 (74.36) | 100 (97.09) | (Ref) | ||
| Yes | 30 (25.64) | 3 (2.91) | 11.494 | 3.389–38.973 | <0.001 |
| Times had stress at work | |||||
| Never | 15 (12.27) | 45 (43.69) | (Ref) | ||
| Sometimes | 72 (61.54) | 56 (54.37) | 3.857 | 1.952–7.619 | <0.001 |
| Several times | 30 (25.64) | 2 (1.94) | 45 | 9.589–211.17 | <0.001 |
HTN: Hypertension, CI: Confidence interval, OR: Odds ratio, Statistical significance was considered at p < 0.05.
Multivariate analysis of factors associated with hypertension among retirees
In the multivariable logistic regression model, three factors remained independently associated with hypertension after controlling for potential confounders. HIV-positive participants had higher odds of hypertension compared with HIV-negative participants (Adjusted odds ratio [AOR] ≈ 18), although the CI was wide. Similarly, those diagnosed with diabetes mellitus were nearly 17 times more likely to have hypertension than non-diabetic pensioners (AOR = 16.87, 95% CI: 1.59–178.84, p=0.019).
Occupational stress also showed a strong association with hypertension. Participants who reported occasional work-related stress had approximately threefold higher odds of hypertension (AOR = 2.90, 95% CI: 1.20–7.02, p=0.018), while those who frequently experienced stress at work had more than thirteenfold higher odds (AOR = 13.51, 95% CI: 2.21–82.83, p=0.005) compared with those who reported no workplace stress. These independent predictors are summarized in Table 5.
| Variables | HTN n (%) | Non-HTN n (%) | AOR | 95% CI | p-value |
|---|---|---|---|---|---|
| HIV/AIDS | |||||
| Negative | 95 (84.07) | 100 (98.04) | (Ref) | ||
| Positive | 18 (15.93) | 2 (1.96) | 18.405 | 3.228–104.93 | 0.001 |
| DM | |||||
| Normal | 102 (87.18) | 102 (99.03) | (Ref) | ||
| High glucose | 15 (12.82) | 1 (0.97) | 16.873 | 1.591–178.84 | 0.019 |
| Ever worked in stressful condition | |||||
| No | 87 (74.36) | 100 (97.09) | (Ref) | ||
| Yes | 30 (25.64) | 3 (2.91) | 3.796 | 0.805–17.897 | 0.092 |
| Times had stress at work | |||||
| Never | 15 (12.27) | 45 (43.69) | (Ref) | ||
| Sometimes | 72 (61.54) | 56 (54.37) | 2.902 | 1.2000–7.021 | 0.018 |
| Several times | 30 (25.64) | 2 (1.94) | 13.514 | 2.205–82.825 | 0.005 |
HTN: Hypertension, DM: Diabetes mellitus, CI: Confidence interval, AOR: Adjusted odds ratio, HIV: Human immunodeficiency virus, AIDS: Acquired immunodeficiency syndrome, Statistical significance was considered at p < 0.05.
DISCUSSION
This study assessed the prevalence of hypertension and its associated factors among pensioners in Kigali City, Rwanda. More than half of the participants (53.2%) were hypertensive, indicating a high burden of disease in this population. This high prevalence may be attributed to the advanced age of participants and the presence of comorbid conditions in this population, including diabetes and HIV infection.[10] The current findings also revealed that hypertension was more common among males (65.8%), consistent with studies from Brazil and Argentina that reported higher prevalence rates among men.[10,12,16]
In this study, hypertension was more common among male participants, suggesting that sex-related differences may be influenced by lifestyle and behavioral factors. Educational attainment also appeared to influence hypertension risk, with most affected participants having secondary or higher education. This may reflect lifestyle factors such as physical inactivity or occupational stress among individuals with higher education levels.[17,25] Occupational history was a relevant factor, with pensioners who had worked in local and central government institutions showing higher hypertension prevalence (46.8%) compared to those in the education or health sectors. This may reflect differences in work-related stress, job demands, or lifestyle patterns associated with these occupations.[19] Behavioral factors, including tobacco and alcohol use, were also associated with hypertension.
In this study, 56.4% of participants reported tobacco use, and 83.6% reported alcohol consumption, which may contribute to the high burden of hypertension.[11] These behaviors are known contributors to elevated blood pressure and cardiovascular risk.[11]
The large AORs observed for HIV status, diabetes, and frequent occupational stress should be interpreted with caution. The wide CIs suggest imprecision, which may be related to small subgroup sizes, sparse data, or residual confounding. These findings indicate strong associations rather than precise estimates of effect magnitude.[23]
Moreover, work-related stress emerged as a strong independent predictor of hypertension.[13,25] The high odds ratios observed among participants experiencing frequent or occasional stress highlight the need for stress management interventions in the workplace and post-retirement settings. Frequent occupational stress showed a strong association with hypertension among pensioners; however, this finding should be interpreted with caution. The large odds ratios observed may partly reflect subjective measurement, recall bias, or small numbers within stress categories rather than a true magnitude of effect. Formal sensitivity analyses to assess the impact of missing BMI data were not conducted, which represents an additional limitation of this study. Body mass index is a well-established indicator of adiposity and has been associated with hypertension in several populations, including elderly adults.[26] Therefore, the presence of missing BMI data may have affected the precision of estimates related to anthropometric risk factors. Formal sensitivity analyses to assess the impact of missing BMI data were not conducted, which represents an additional limitation of this study.
Future longitudinal and nationally representative studies are recommended to further examine the pathways underlying these associations and to inform effective strategies for the prevention and control of hypertension among older adults in Rwanda.
Strengths and limitations
This study has several strengths. It included a relatively large and diverse sample of pensioners from all three districts of Kigali City, enhancing representativeness and the validity of findings. The use of standardized data collection tools and objective measurements, along with multivariable analysis, strengthened the reliability of the results and minimized confounding. The study also contributes valuable evidence on hypertension among pensioners, a population that has been understudied in Rwanda.
However, the cross-sectional design limits causal inference between risk factors and hypertension. Self-reported information on behavioral and medical histories may be subject to recall bias. Furthermore, as the study was conducted only in Kigali City, the results may not fully reflect the situation in rural or semi-urban settings. A substantial proportion of participants had missing anthropometric data, which limited the inclusion of BMI in the full analytical sample. This may have introduced selection bias if participants with available BMI measurements differed systematically from those without measurements. Consequently, associations involving BMI should be interpreted with caution. Because of the cross-sectional nature of this study, causal relationships between the examined factors and hypertension cannot be inferred. Furthermore, occupational stress was assessed retrospectively, which may introduce recall bias and limit the ability to determine whether stress preceded the onset of hypertension. HIV and diabetes status were primarily based on self-reported information and available medical documentation, which may have resulted in misclassification bias. Undiagnosed cases or inaccurate recall of prior diagnoses cannot be ruled out and may have affected the observed associations. Future nationwide and longitudinal studies are recommended to confirm these findings and to better elucidate the temporal relationships underlying the observed associations. The findings of this study should be interpreted in light of limited generalizability. The study population consisted exclusively of urban pensioners receiving formal pensions in Kigali City. Older adults from rural areas and those who worked in the informal sector and do not receive formal pensions were not represented. Given that a substantial proportion of older adults in Rwanda fall outside formal pension schemes, the results may not be generalizable to the broader older adult population in the country.
CONCLUSION
This study revealed a high prevalence of hypertension (53.2%) among pensioners in Kigali City. HIV infection, diabetes mellitus, and occupational stress were identified as strong independent predictors of hypertension in this population. These findings highlight the need for targeted hypertension prevention and management strategies among urban pensioners receiving formal pensions in Kigali City.
Efforts to reduce hypertension should include regular blood pressure screening, lifestyle modification programs, and targeted education on stress management, physical activity, and dietary practices. Integrating hypertension and cardiovascular risk assessment into HIV and diabetes care could improve early detection and control. Public health authorities should also strengthen community-based interventions that promote smoking cessation, reduce harmful alcohol use, and provide psychosocial support among urban pensioners in Kigali City.
Finally, long-term policies focusing on preventive health services for pensioners are needed to mitigate the rising burden of hypertension and its associated complications in Kigali City.
Acknowledgment:
The authors express their sincere gratitude to the University of Rwanda, College of Medicine and Health Sciences, for providing ethical and administrative support. Appreciation is extended to the Rwanda Social Security Board (RSSB), the Rwandese Association of Retired (ARR), the City of Kigali authorities, and all participants who generously contributed their time to this research. Special thanks are also given to the research assistants for their commitment during data collection.
Author Contributions:
PN: Conceived and designed the study, collected and analyzed the data, and drafted the manuscript; AN and MJ: Supervised the research, contributed to data interpretation, and critically revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript.
Ethical approval:
The research/study approved by the Institutional Review Board at Institutional Review Board of the University of Rwanda, College of Medicine and Health Sciences, number (Reference No. CMHS/IRB/278/2023), dated July, 2023..
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that artificial intelligence (AI)-assisted technology was used solely for language refinement and improvement of manuscript clarity. No AI tools were used for data analysis, interpretation of results, or generation of scientific content.
Financial support and sponsorship: Nil.
References
- Prevalence and associated factors of hypertension among adults in Ethiopia: A community based cross-sectional study. BMC Res Notes. 2017;10:1-8.
- [CrossRef] [PubMed] [Google Scholar]
- The prevalence of hypertension and influencing factors among the employees of a university hospital. Afr Health Sci. 2020;20:1725-33.
- [CrossRef] [PubMed] [Google Scholar]
- Hypertension in the older person: Is age just a number? Aging Clin Exp Res. 2022;34:2649-58.
- [Google Scholar]
- Working and hypertension: Gaps in employment not associated with increased risk in 13 European countries, a retrospective cohort study. BMC Public Health. 2014;14:1-6.
- [CrossRef] [PubMed] [Google Scholar]
- The impact of retirement on cardiovascular disease and its risk factors: A systematic review of longitudinal studies. Gerontologist. 2020;60:E367-77.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence, awareness, treatment and control of hypertension among adults in Kenya: Cross-sectional national population-based survey. East Mediterr Heal J. 2020;26:923-32.
- [CrossRef] [PubMed] [Google Scholar]
- Non-Communicable Diseases in an Ageing World. 2011. Available from: https://www.ilcuk.org.uk/files/pdf_pdf_185.pdf [Last accessed on 2025 Oct 24]
- [Google Scholar]
- Hypertension in older adults: Assessment, management, and challenges. Clin Cardiol. 2020;43:99-107.
- [CrossRef] [PubMed] [Google Scholar]
- Rwanda NonCommunicable Diseases Risk Factors Study Rwanda Rwanda: Ministry of Health and Family Welfare; 2022.
- [Google Scholar]
- The prevalence and treatment of hypertension in the elderly population of the Mexican institute of social security. Salud Publica Mex. 2001;43:415-20.
- [CrossRef] [PubMed] [Google Scholar]
- Trends in prevalence of hypertension in Argentina in the last 25 years: A systematic review of observational studies. Rev Panam Salud Publica. 2015;38:496-503.
- [Google Scholar]
- Blood Pressure and Its Associated Risk Factors among Older Adults in Kenya Nairobi, Kenya: School of Public Health and Applied Human Sciences, Kenyatta University; 2020.
- [Google Scholar]
- Aging and hypertension among the global poor-panel data evidence from Malawi. PLOS Glob Public Health. 2022;2:e0000600.
- [CrossRef] [PubMed] [Google Scholar]
- Hypertension in elderly persons: Its prevalence and associated cardiovascular risk factors in Tainan City, Southern Taiwan. J Gerontol Ser a Biol Sci Med Sci. 2000;55:M463-8.
- [CrossRef] [PubMed] [Google Scholar]
- Fatores associados à prevalência de hipertensão e medidas de controle entre idosos residentes no município de São Paulo, Brasil. Cad Saude Publica. 2013;29:2275-86.
- [CrossRef] [PubMed] [Google Scholar]
- To Determine the Prevalence of Hypertension and its Lifestyle Risk Factors in Amhara Region of Debre Birehan Town among Zonal Civil Servants, Ethiopia. United States: Research Square; 2020:22.
- [CrossRef] [Google Scholar]
- Prevalence of hypertension and associated risk factors in older adults in Kurdistan, Iraq. East Mediterr Heal J. 2020;26:268-75.
- [CrossRef] [PubMed] [Google Scholar]
- The burden of hypertension in Sub-Saharan Africa: A four-country cross sectional study. BMC Public Health. 2015;15:1211.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence and control of hypertension in a Niger Delta semi Urban community, Nigeria. Pharm Pract. 2013;11:24-9.
- [CrossRef] [PubMed] [Google Scholar]
- The cost of providing hypertension health care in public health facilities case study of the NCD clinic at Rwinkwavu district hospital. MOJ Public Health. 2020;9:35-40.
- [CrossRef] [Google Scholar]
- National Strategy and Costed Action Plan for the Prevention and Control of Non-Communicable Diseases in Rwanda. Ministry of Health. 2020 Available from: https://www.moh.gov.rw/fileadmin/user_upload/moh/publications/strategic_plan/rwanda_national_ncd_strategy_costed_action_plan_final_12072021.pdf [Last accessed on 2025 Oct 24]
- [Google Scholar]
- (ref NST1) (ref NST1) 2017. Available from: https://unfccc.int/files/secretariat/regional_collaboration_centres/rcc_kampala/application/pdf/day1_module2_ppt2_overview_of_the_mitigation_component_of_rwandas_ndc.pdf [Last accessed on 2025 Oct 24]
- [Google Scholar]
- Prevalence, treatment patterns, and risk factors of hypertension and pre-hypertension among Bangladeshi adults. J Hum Hypertens. 2018;32:334-48.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence of hypertension and its relationship with adiposity among rural elderly population in India. Int J Clin Cardiol. 2014;1:3.
- [CrossRef] [Google Scholar]