Abstract
BACKGROUND: Despite the growing burden of cardiovascular diseases in the Lao People's Democratic Republic (Lao PDR), studies on hypertension-a key modifiable risk factor-remain limited. There is an urgent need to understand regional differences in hypertension prevalence and its management, particularly across rural and urban settings. Health locus of control (HLOC), reflecting individuals' beliefs about health determinants, may influence hypertension awareness, treatment, and control. This study estimated the prevalence and management of hypertension and examined their associations with HLOC among middle-aged adults in Lao PDR by residential area. METHODS: A cross-sectional, population-based survey was conducted among adults aged 40 to 59 years living in Vientiane Capital and Vientiane Province using a multistage cluster sampling approach. The analytic sample size for estimating hypertension prevalence included 922 participants, while 441 participants with hypertension (urban: n = 230; rural: n = 211) were included in the association analysis. Blood pressure was measured using a digital automatic blood pressure monitor. Hypertension awareness and treatment were assessed through self-report, and control was defined based on measured blood pressure. HLOC was measured using the Multidimensional Health Locus of Control Scale (internal, chance, doctor, and other people subscales). The Horvitz-Thomson estimator was used to calculate prevalence, and weighted logistic regression models were used to examine associations. RESULTS: Of the 922 participants, 52.2% were aged 40-49 years, 55.4% were female, and 86.6% identified as Lao-Tai, the majority ethnic group. Among those with hypertension, weighted percentages of awareness, treatment, and control were 43.4%, 42.3%, and 17.8%, respectively. In urban areas, higher doctor and other people HLOC scores were associated with greater odds of awareness, treatment, and control. In rural areas, higher internal HLOC score was associated with greater odds of hypertension control. CONCLUSIONS: The findings highlight the need for targeted actions to prevent and manage hypertension in Lao PDR. Health beliefs-including differences in health locus of control between urban and rural populations-should be considered in the development of culturally tailored interventions to improve hypertension outcomes.