The World Health Organization (WHO, 2013), defines hypertension (HTN) or uncontrolled blood pressure (BP), as a systolic and/or diastolic blood pressure equal to or above 140/90 mmHg respectively. Uncontrolled blood pressure stands as a major risk factor for several cardiovascular events, including ischemic heart disease, myocardial infarction, hemorrhagic stroke, and heart failure (Lippi et al., 2020). Despite remarkable progress in the field of healthcare, plus measures put in place to prevent and control cardiovascular disease (CVD), hypertension remains a significant public health problem worldwide. In 2019, the global prevalence of hypertension in adults aged 30–79 years was 32% in women and 34% in men(Nguyen & Chow, 2021). However, only 54% of adults with the condition are diagnosed, 42% receive treatment, and only 21% have their blood pressure controlled (WHO, 2023a).

In Sub-Saharan Africa (SSA), WHO estimates that 46% of adults, aged above 25 years, have some degree of hypertension (Yoruk et al., 2018). According to Zhou et al. (2021a), the prevalence of adult hypertension in Sub-Saharan African countries was 48% in women and 34% in men in 2019. However, in the less developed countries, including SSA, it is estimated that 46% of the people with hypertension are not even aware that they have this condition (WHO, 2023-a).

In the less developed nations, diagnosis and treatment of hypertension are often delayed due to a a lack of awareness and screening, leading to increased risk of complications and mortality (Dhungana et al., 2016). In SSA, screening, diagnosis, and treatment are inadequate and a recent study found that 40% of individuals with the condition in East and West Africa were unaware of their status (Ibekwe, 2015). In Kenya, reports have given variable estimates for the prevalence of hypertension: including 44.7% (Ondieki et al., 2021) and 20.8% (Mecha et al., 2020). Correspondingly, in Kenya, only 49% of adults with the condition are diagnosed, with 21% treated, and only 8% have their blood pressure controlled (WHO, 2023b). These stats help to underscore the necessity for improved awareness, detection and management of adult hypertension.

Uncontrolled blood pressure is the leading cause of death globally, attributed to 10.4 million deaths in 2017 (Stanaway et al., 2018). Low- and middle-income countries (LMICs) suffer the most, with less than 20% of individuals achieving adequate control, while hypertensive-related cardiovascular deaths have been rising over the past 3 decades (Ferdinand and Brown, 2021; Ogunniyi et al., 2021). More than 75% of deaths caused by cardiovascular diseases occur in the LMICs, attributed to undiagnosed, or to untreated, or inadequately treated hypertension sources (WHO, 2019). For many people in such countries, detection is often late in the course of the disease, and people die at a younger age from CVDs often in their most productive years (WHO, 2019).

Likewise, in Kenya, cardiovascular diseases are a significant public health burden, accounting for approximately 26% of all Non-Communicable Diseases (NCD)-related deaths (Wekesah et al., 2020). Moreover, cardiovascular-related complications required long-term hospitalization, putting families and individuals into financial crisis due to out-of-pocket payment. At worst catastrophic health expenses from cardiovascular issues disproportionately affect low-income communities, perpetuating suffering, and deepening and expanding socioeconomic disparities (Gheorghe et al., 2018).

In addition to lifestyle risk factors, like a poor diet, physical inactivity, alcohol and tobacco use, the development and management of hypertension are significantly influenced by an individual’s Social Determinants of Health (SDOH). Overall, hypertension is significantly impacted by the SDOH characteristics, such as age, gender, education, income, employment and job stability, access to health care and social support networks (Virani et al., 2021; Wang, Kho, & French, 2020). The burden of hypertension and related cardiovascular issues fall disproportionately on those from socially disadvantaged backgrounds (Benjamin et al., 2019; Minhas et al., 2023).

Because they are more likely to be exposed to suspect conditions and have less access to good screening and initial treatment than people with favorable socioeconomic standing, vulnerable and socially disadvantaged individuals suffer from hypertension more often and die sooner from cardiovascular diseases (Havranek et al., 2015). Poor SDOH can shape an individual’s unhealthy behaviors, fostering unhealthy practices that directly impact stress levels, leading to a heightened sympathetic activity, key markers of inflammation, and enhanced susceptibility to uncontrolled hypertension and then cardiovascular issues (Lurbe and Ingelfinger, 2021). Limited access to affordable, high-quality health care compounds these challenges, hindering timely diagnosis and treatment, and leading to an accelerated progression of problems with high morbidity and mortality (Gheorghe et al., 2018). Indeed, cardiovascular events, including heart attacks, strokes, and mental fitness, are significantly influenced by SDOH (Jilani et al., 2021).

Reducing and controlling hypertension is one of WHO’s worldwide goals for the prevention of non-communicable diseases (NCD Risk Factor Collaboration, 2021). Despite significant efforts to address the challenges associated with blood pressure control, social determinants remain an issue of concern with disparities in accessing the quality of healthcare services (Zhou B et al., 2021a; Zhou B et al., 2021b). Understanding the relationship between SDOH and adequate blood pressure control is necessary to design appropriate interventions and key implementation strategies to improve access to quality healthcare and reduce the burden of any cardiovascular diseases in the lesser developed nations. As such, this research study aimed at discerning the latent association between SDOH and blood pressure intervention among adult patients with hypertension receiving treatment at the Murang’a County Referral Hospital in Kenya.