🟠 Moderate Evidence
Hypertension remains one of Bangladesh’s leading non-communicable disease burdens, yet access to diagnosis and treatment is sharply stratified by wealth. A nationally representative survey of 14,178 adults reveals that wealthier Bangladeshis are 2.3 times more likely to be diagnosed with hypertension than poorer counterparts, and treatment gaps widen further along the care pathway, according to research published in PLOS Global Public Health by Dr. Md. Abdur Rafi and colleagues from the Bangladesh health research community.
Key takeaways
- 22% of Bangladeshi adults have hypertension, but diagnosis rates are 2.3 times higher in wealthy populations than poor populations
- Only 44% of treated patients achieve blood pressure control, with the poorest quintiles receiving less treatment overall
- Socioeconomic inequality persists across the entire care cascade—from detection through control—suggesting systemic barriers to equitable hypertension management
Study at a Glance
| Source | PLOS Global Public Health |
| Study type | Cross-sectional analysis of nationally representative survey data |
| Sample size | N = 14,178 adults aged ≥18 years |
| Population | Bangladesh Demographic and Health Survey (BDHS) 2022 participants |
| Country | Bangladesh |
Hypertension care cascade by wealth quintile in Bangladesh
Proportion advancing through diagnosis, treatment, and control stages, stratified by economic status. Data from BDHS 2022.
Source: PLOS Global Public Health, 2024 | Georgian Medical Journal News
The diagnosis gap: who gets screened
Among the 3,142 adults with hypertension in the survey, only 59% (1,863 individuals) had received a prior diagnosis. This aggregate figure masks a stark inequality: the BDHS 2022 analysis shows that wealthy individuals were significantly more likely to know their hypertension status. Using the Relative Index of Inequality (RII)—a standard epidemiological measure of socioeconomic disparity—the diagnosis gap yielded an RII of 2.33, meaning the richest populations had 2.33 times the odds of diagnosis compared with the poorest.
This disparity likely reflects unequal access to healthcare infrastructure and screening programmes in Bangladesh. Wealthier households have greater capacity to afford primary care visits, blood pressure monitoring, and preventive health checks, while lower-income populations may access healthcare only when symptomatic, missing opportunities for early detection.
Treatment access: the second barrier
The second step in the care cascade—treatment initiation—revealed even steeper inequality. Among the 1,863 diagnosed individuals, 72.5% (1,350 people) reported receiving antihypertensive medication. However, treatment access was strongly patterned by wealth, with the study authors reporting a Relative Index of Inequality of 2.56 for treatment—meaning the richest quintile had 2.56 times the odds of accessing treatment compared with the poorest quintile.
Cost of medications, availability of affordable generics, and distance to pharmacies are likely drivers. Bangladesh has made progress in antihypertensive drug availability through its Essential Medicines List, yet private and out-of-pocket costs remain substantial barriers for low-income populations. The World Health Organization estimates that approximately 46% of adults with hypertension globally are aware of their condition, but treatment rates drop sharply in lower-income countries, consistent with the Bangladesh findings.
Control remains elusive even among the treated
The final stage—blood pressure control among those treated—revealed the most sobering statistic: only 44% of treated patients (594 of 1,350) achieved systolic blood pressure <140 mmHg and diastolic <90 mmHg at survey measurement. The PLOS Global Public Health report indicates this low control rate reflects both inadequate medication efficacy and adherence challenges. Socioeconomic inequality persisted at this stage as well: the Concentration Index (CnI) for control was 0.18, indicating a pro-rich distribution favouring wealthier treated patients.
Additional analysis identified key clinical correlates. Older age (adjusted odds ratio [aOR] 12.5 for age ≥60 years), female sex (aOR 1.57), overweight status (aOR 3.41), obesity (aOR 5.45), and type 2 diabetes mellitus (aOR 2.20) were all independently associated with higher hypertension prevalence. These factors did not fully explain the wealth gradient, suggesting that structural and health-system factors—not just underlying disease burden—drive the observed inequalities. Read more on GMJ News’s Global Health coverage.
Only 44% of hypertensive Bangladeshis on treatment achieved blood pressure control, with wealthier patients twice as likely to reach target blood pressure as poorer counterparts—evidence of a systemic care gap that extends throughout the treatment pathway.
— Dr. Md. Abdur Rafi and colleagues, Bangladesh health research community (PLOS Global Public Health, 2024)
Implications for Bangladesh’s health system
Bangladesh has prioritized hypertension control as part of its non-communicable disease strategy, including awareness campaigns and Essential Medicines List inclusion. However, this nationally representative evidence reveals that awareness alone is insufficient; structural barriers to equitable diagnosis and treatment persist. The Health Policy landscape requires targeted investment in community health worker screening, subsidized medication access for low-income populations, and integrated primary care pathways that reduce out-of-pocket costs.
What this means
Frequently asked questions
What defines hypertension in this study?
According to the BDHS 2022 analysis, hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or previous diagnosis of high blood pressure. This aligns with standard clinical definitions used globally.
Why is the control rate so low (only 44%)?
Low control rates in resource-limited settings stem from multiple factors: inadequate medication access, poor adherence due to side effects or cost, insufficient follow-up monitoring, and suboptimal medication titration. The Bangladesh study suggests systemic gaps in treatment intensification and patient support.
Can the wealth gap be closed?
Yes, but it requires structural intervention. Countries including Sri Lanka and Iran have reduced hypertension inequality through subsidized medications, task-shifting to community health workers, and community screening programmes. Bangladesh’s health system has the platform to implement similar equity-focused strategies.
This nationally representative evidence identifies a critical bottleneck in Bangladesh’s hypertension care system: even among those diagnosed and treated, control remains suboptimal, particularly for lower-income populations. Without targeted policy and health system reforms—including medication subsidy, equitable screening access, and intensified follow-up—the burden of uncontrolled hypertension will continue to disproportionately affect poorer Bangladeshis, widening health inequities and driving cardiovascular disease mortality.
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