Persistent Hypertension Awareness Gap and Temporal Trends in Indonesia: A 16-Year Analysis of National Health Surveys

Abstract

Background:
Hypertension is a key modifiable risk factor for cardiovascular and chronic kidney diseases. In Indonesia, surveys show a high prevalence based on measurements, but healthcare detection remains limited.

Objective:
To assess trends in measured hypertension, physician-diagnosed hypertension, and the diagnostic gap in Indonesia over 16 years.

Methods:
This secondary analysis used nationally representative surveys (Riskesdas 2007, 2013, 2018, and SKI 2023). Adults ≥18 years were included. Measured hypertension was defined as systolic ≥140 mmHg and/or diastolic ≥90 mmHg. Diagnosed hypertension was based on self-reported physician diagnosis or antihypertensive use. The diagnostic gap was the difference between measured and diagnosed prevalence.

Results:
Measured hypertension remained high (25.8%–34.1%), while diagnosed cases were low (7.2%–9.4%). The diagnostic gap persisted: 24.5 percentage points (2007), decreased to 16.4 (2013), then increased to 25.7 (2018) and remained high at 22.2 (2023). Overall, only a minority of individuals were aware of their condition. This gap was consistent across sociodemographic groups and regions.

Conclusion:
The hypertension diagnostic gap in Indonesia remains substantial and has tended to widen. Detection efforts have not kept pace with disease burden, highlighting the need to strengthen early screening and diagnosis to reduce cardiovascular and kidney disease risk.