Prevalence and associated factors of hypertension in women of reproductive age in Bangladesh based on JNC-8 & AHA-2017 guidelines: Evidence from Bangladesh Demographic & Health Survey 2022

Background In Bangladesh, using the 2017 ACC/AHA guideline has notably altered both the prevalence estimates and the associated factors compared to JNC 7 guideline. According to these guidelines, we investigated the most-recent data to compare hypertension prevalence and risk factors in women of reproductive age (WRA). Methods We analyzed data from the nationally representative Bangladesh Demographic and Health Survey 2022. Among eligible WRA, blood pressure was measured three times ≥5 minutes apart with an automated device by trained personnel. The mean of the 2nd and 3rd readings was used. Hypertension was defined based on JNC-8 (SBP ≥140 mmHg or DBP ≥90 mmHg or current antihypertensive use) and AHA-2017 (SBP ≥130 mmHg or DBP ≥80 mmHg) criteria. Prevalence ratios (PRs) were estimated to assess the relative burden of hypertension. Poisson regression models with robust variance were used to identify associated factors. Results Among 4,814 participants, hypertension was present among 13.6% (655) and 40.8% (1962) according to the JNC-8 criteria and 2017 ACC/AHA guidelines, respectively. The prevalence among rural residents more than doubled (from 16.9%, 95% CI: 15.6–18.4% to 40.2%, 95% CI: 38.3–42.1%). Among women aged 18–29, it increased from 6.4% (95% CI:5.1–7.9%) to 25.8% (95% CI:23.5–28.2%). Similar two- to threefold increases were observed across BMI, education, wealth index, contraceptive use, and comorbidities. In adjusted models, age, obesity, and oral contraceptive use were consistently associated with higher hypertension risk under both JNC-8 and ACC/AHA. Diabetes was associated with higher prevalence only under the ACC/AHA definition. Women in Rajshahi and Sylhet region had higher risk under JNC-8. Across guidelines, obesity showed the strongest association. Conclusion The prevalence of hypertension among reproductive-aged women in Bangladesh is high, especially under the 2017 ACC/AHA guidelines. Key risk factors include age, obesity, diabetes, and oral contraceptive use, with notable disparities by residence and socioeconomic status. Effective public health interventions that tackle these risk factors will be key to alleviating hypertension and advancing cardiovascular health among reproductive-aged women in Bangladesh.