Abstract
OBJECTIVES: To examine national trends and determinants of hypertension diagnosis, treatment and control in Indonesia, and to identify factors influencing the performance of hypertension care across three waves of national health surveys. DESIGN: Repeated cross-sectional analysis of three nationally representative health surveys (2013, 2018 and 2023). SETTING: Household-based, population-level surveys conducted across all provinces of Indonesia, representing primary healthcare settings. PARTICIPANTS: Adults aged ≥18 years included in the 2013, 2018 and 2023 Indonesian National Health Research surveys (Riset Kesehatan Dasar and Survei Kesehatan Indonesia). Participants with complete blood pressure measurements and information on diagnosis and treatment were included; those with missing data were excluded. The weighted sample sizes were representative of Indonesia's adult population by sex, age group and urban-rural residence. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were hypertension prevalence, diagnosis, treatment and control rates. Secondary analyses assessed sociodemographic, economic and health system factors associated with each stage of the hypertension care cascade using multivariate logistic regression. All estimates were adjusted for survey design and population weights. RESULTS: Hypertension crude prevalence increased from 27.9% (95% CI 27.7% to 28.2%) in 2013 to 31.6% (95% CI 31.4% to 31.8%) in 2023. Diagnosis rates declined from 33.0% in 2013 to 24.1% in 2018, then slightly rose to 26.9% in 2023. Treatment rates doubled from 10.4% to 22.4% over the decade, corresponding to an estimated 10 million additional adults receiving antihypertensive therapy. However, control rates improved only modestly, from 2.3% to 4.2%, leaving over 95% of hypertensive adults with uncontrolled blood pressure. Women, urban residents and individuals in higher wealth quintiles had consistently better outcomes across all stages of care. CONCLUSIONS: Indonesia faces a growing hypertension burden, with most cases being undiagnosed. Although treatment coverage has doubled over the past decade, control rates have remained stagnant, and disparities between wealth groups persist. Strengthening long-term management, follow-up and equitable care is essential to improve outcomes.