Study participants’ characteristics (n = 1008).

Hypertension affects 1.28 billion adults globally, with two-thirds residing in low- and middle-income countries. In Nepal, about 60% of hypertensive individuals in urban settings have uncontrolled blood pressure, but the situation in rural settings is unknown. We aimed to determine the prevalence and factors associated with uncontrolled blood pressure among individuals diagnosed with high blood pressure, in a rural community in Nepal.We conducted a cross-sectional study among 1,008 individuals aged ≥30 years in Namobuddha Municipality, Nepal, who had a systolic blood pressure (SBP) ≥130 mmHg, a diastolic blood pressure (DBP) ≥85 mmHg, or were currently using antihypertensive medication. Participants were recruited through screening camps conducted in various parts of the study area. Demographic information, medical history, and lifestyle-related data were collected through face-to-face interviews, and anthropometric measurements were obtained. For analysis, uncontrolled blood pressure was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. Descriptive statistics and multiple logistic regression analyses with 95% confidence intervals were conducted to assess the factors associated with uncontrolled blood pressure.About 64% of participants with diagnosed high blood pressure had uncontrolled blood pressure. After adjusting for age, gender, ethnicity, smoking, alcohol use, and physical activity, factors significantly associated with uncontrolled blood pressure included higher body mass index and poor adherence to antihypertensive medication. Specifically, each 1 kg/m² increase in BMI was associated with 7% higher odds of uncontrolled blood pressure (aOR: 1.07; 95% CI: 1.02–1.11), and adherence to antihypertensive medication lowered the odds of uncontrolled blood pressure (aOR: 0.21; 95% CI: 0.14–0.38).There is high prevalence of uncontrolled blood pressure among individuals diagnosed with high blood pressure in a rural setting. BMI, and poor adherence to antihypertensive medications are associated with uncontrolled high blood pressure. Targeted interventions to improve medication adherence and reduce BMI could enhance blood pressure control among hypertensive individuals in rural Nepal.