ABSTRACT:
The burden of non-communicable diseases (NCDs) is increasing rapidly worldwide and remains the leading cause of global mortality. In Malawi, findings from the STEPwise approach to NCD surveillance (STEPS) indicate that approximately 30% of adults have elevated blood pressure (BP) but are unaware of their condition and do not seek medical care. This study aimed to assess and compare dietary and lifestyle risk factors and the prevalence of hypertension among adults in urban and rural areas of Lilongwe, Malawi. A descriptive comparative cross-sectional study design was used. A random sampling method selected 240 adult participants with unknown hypertension status. Data were analyzed using descriptive statistics and chi-square tests in IBM SPSS® version 25.0 (Chicago, USA). Multiple regression analysis was conducted to determine associations between risk factors and hypertension, with statistical significance set at p<0.05. Of the participants, 57.5% were female, with a mean age of 36.6 ± 10.9 years. The overall prevalence of hypertension was 7.5%, higher in rural areas (10%) than urban areas (5%). Hypertension was more prevalent among rural residents and individuals aged 55–64 years. Risk behaviors were common: 70.4% added salt during cooking or eating, 96.5% were not regular vegetable consumers, 22.6% did not consume fruits, 30.3% had a history of alcohol use, 15.9% reported smoking, and 2.4% were physically inactive. Regression analysis showed no significant association between hypertension and dietary (R²=0.016, p=0.567) or lifestyle risk factors (R²=0.872, p=0.064). However, age (β=0.053, p=0.002) and educational level (β=−0.027, p=0.021) were significant predictors. The study demonstrates that hypertension exists among adults with unknown status and is significantly influenced by age, education, and occupation. These findings highlight the need for public health education to improve awareness and early detection of hypertension in the general population.