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Background  Hypertension is a leading cause of cardiovascular diseases and a growing public health problem in many developed and developing countries. However, population-based data to inform policy development are scarce in Rwanda. This nationally representative study aimed to determine population-based estimates of the prevalence and risk factors associated with hypertension in Rwanda.    Methods  We conducted secondary epidemiological analysis of data collected from a cross-sectional population-based study to assess the risk factors for NCDs using the WHO STEPwise approach to Surveillance of non-communicable diseases (STEPS). Adjusted odds ratios at 95% confidence interval were used to establish association between hypertension, socio-demographic characteristics and health risk behaviors.    Results  Of the 7116 study participants, 62.8% were females and 38.2% were males. The mean age of study participants was 35.3 years (SD 12.5). The overall prevalence of hypertension was 15.3% (16.4% for males and 14.4% for females). Twenty two percent of hypertensive participants were previously diagnosed. A logistic regression model revealed that age (AOR: 8.02, 95% CI: 5.63–11.42,  p  < 0.001), living in semi-urban area (AOR: 1.30, 95% CI: 1.01–1.67,  p  = 0.040) alcohol consumption (AOR: 1.24, 95% CI: 1.05–1.44,  p  = 0.009) and, raised BMI (AOR: 3.93, 95% CI: 2.54–6.08,  p  < 0.001) were significantly associated with hypertension. The risk of having hypertension was 2 times higher among obese respondents (AOR: 3.93, 95% CI: 2.54–6.08,  p -value < 0.001) compared to those with normal BMI (AOR: 1.74, 95% CI: 1.30–2.32,  p -value < 0.001). Females (AOR: 0.75, 95% CI: 0.63–0.88,  p  < 0.001) and students (AOR: 0.45, 95% CI: 0.25–0.80,  p  = 0.007) were less likely to be hypertensive.    Conclusion  The findings of this study indicate that the prevalence of hypertension is high in Rwanda, suggesting the need for prevention and control interventions aimed at decreasing the incidence taking into consideration the risk factors documented in this and other similar studies.    Electronic supplementary material  The online version of this article (doi:10.1186/s12889-017-4536-9) contains supplementary material, which is available to authorized users.

bmc public health

A population-based national estimate of the prevalence and risk factors associated with hypertension in Rwanda: implications for prevention and control