A narrative review of epidemiology risk factors and health system responses to hypertension in low and middle income countries between 2015 and 2025

Abstract Hypertension continues to be a leading factor in cardiovascular morbidity and mortality worldwide. This narrative review synthesises evidence from 2015 to 2025 on the epidemiology, risk factors, and health system responses to hypertension across LMICs. The results show that the prevalence varied across regions, and that awareness, treatment, and control are all consistently low. Key determinants encompass behavioural, socioeconomic, environmental, and health system factors that interact to influence hypertension risk and outcomes. Although interventions like community-based care, task-shifting, and digital health technologies exhibit promise in enhancing detection and management, their efficacy is hindered by fragile health systems, restricted access to medications, and insufficient implementation capacity. The review also points out important limitations in the availability of consistent nationally representative surveillance data and repeated population-based surveys across many LMICs, which makes it hard to draw clear conclusions about patterns over time. In general, dealing with hypertension in LMICs requires strategies that are tailored to the situation and focus on the whole system. These strategies should strengthen primary healthcare, make it easier to access important medicines, and improve surveillance and implementation research.