Stratified analysis of socioeconomic status, hypertension burden and drug compliance in South-Eastern Nigeria

Background: Despite global advances in health care, low socioeconomic status (SES) remains the greatest predictor of cardiovascular morbidity and mortality. Hypertension contributes significantly to this burden of cardiovascular diseases worldwide. This study investigated the structural impact of social determinants of health such as the level of education, occupational status, income, and family history of hypertension on hypertension prevalence and medication compliance.
Methods: Using convenience sampling, a cross-sectional study was conducted among 243 participants with baseline knowledge of hypertension in markets and consulting rooms across South-Eastern Nigeria. Data on demographics, income, education, and occupation were captured via structured questionnaires. Body mass index (BMI) and blood pressure (BP) were assessed and recorded using standardized clinical protocols. Hypertension was defined as BP of 140/90 mmHg or active treatment with antihypertensive medication and BMI was defined as underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 24.0 kg/ m2), overweight (24.0 kg/m2 ≤ BMI < 28.0 kg/m2) and obesity (>28.0 kg/m2). 
Results: The study showed a significant association between low socioeconomic indicators and hypertension. Highlighted by the inverse relationship existing between the levels of education and prevalence of hypertension; a disproportionate number of hypertensive individuals only had a primary school education. This underscored the protective effect observed in those with tertiary education. Another significant association was with occupational status, as a higher prevalence of hypertension was noted among unemployed individuals and artisans, whereas business owners, self-employed individuals, and skilled professionals were largely non-hypertensive. Paradoxically, absolute income did not correlate significantly with prevalence; this finding could be attributed to a highly homogenous sample (85% earning >50,000 NGN). These socioeconomic vulnerabilities were further compounded by clinical risks, including advanced age (65–90 years), elevated BMI, and a positive family history (66.7%). Finally, while medication non-compliance drastically foreruns blood pressure control (77.1% uncontrolled vs. 19.4% in compliant peers), compliance behavior was surprisingly independent of demographic and socioeconomic factors.
Conclusion: These findings highlight the almost linear relationship between hypertension and socioeconomic factors, as identified by the significant association of lower educational level, unstable/variable income occupations (unemployment and artisan trades) and hypertension. Public health strategies must create targeted, evidence-based, cardiovascular screening and support systems that are readily accessible to vulnerable occupational sectors.  Health policies and clinical interventions must also incorporate targeted health literacy and advocacy programs for high-risk groups to improve health outcomes.