Silent Burden: Undiagnosed Hypertension Among Adults Attending Outpatient Clinics in Urban Centers

Abstract

Background: Hypertension remains a leading risk factor for cardiovascular morbidity, yet up to one-third of patients remain undiagnosed, particularly in busy outpatient settings.

Objective: To determine the prevalence of undiagnosed hypertension among adults attending outpatient clinics and identify predictors of missed diagnosis.

Methods: A cross-sectional study of 2,436 adults was conducted across 6 tertiary outpatient clinics in Italy (Jan–Dec 2023). Blood pressure was measured using standardized protocols. Data on demographics, comorbidities, and health-seeking behaviors were collected. Logistic regression identified predictors of undiagnosed hypertension.

Results: The prevalence of undiagnosed hypertension was 17.8%. Independent predictors included obesity (OR 2.6, 95% CI 1.9–3.5, p < 0.001), male sex (OR 1.9, 95% CI 1.4–2.7, p < 0.001), and low health literacy (OR 2.3, 95% CI 1.6–3.2, p < 0.01).

Conclusion: Nearly one in five adults attending outpatient clinics had undiagnosed hypertension. Opportunistic screening programs in outpatient settings could significantly reduce the hidden burden of hypertension.