Association between Educational Level and Hypertension Severity among Adults: A Cross-Sectional Study

Abstract

Hypertension is a major public health problem and a leading contributor to cardiovascular morbidity and premature mortality. Beyond biological determinants, hypertension outcomes are shaped by social determinants of health, including educational attainment, which influences health literacy, self-care behaviors, access to health services, and adherence to antihypertensive therapy. This study aimed to examine the association between educational level and hypertension grade among adults with hypertension. An analytical observational cross-sectional design was conducted at Samata Public Health Center (Puskesmas Samata), Gowa Regency, Indonesia. The population comprised 530 registered hypertension patients recorded in December 2024. Blood pressure measurements were obtained during routine clinical visits in February 2025. Sample size estimation using Slovin’s formula with a 10% margin of error yielded a minimum of 84 participants; to improve representativeness and anticipate incomplete data, the sample size was increased by approximately 20%, resulting in 100 respondents included in the analysis. Educational level was classified as elementary school, junior high school, senior high school, and higher education. Hypertension grade was categorized into Grade 1, Grade 2, and Grade 3 based on standard clinical classification. Descriptive statistics were presented as frequencies and percentages, and the association between educational level and hypertension grade was assessed using the Gamma test because both variables were ordinal. Most respondents had senior high school education (39%) and were classified as having Grade 1 hypertension (57%). The Gamma test showed a statistically significant inverse association between educational level and hypertension grade (γ = −0.518; p 0.000), indicating that higher educational attainment tended to be associated with lower hypertension grade. These findings underscore the importance of targeted, literacy-sensitive hypertension education and management strategies for individuals with lower educational backgrounds to prevent disease progression and reduce health disparities.