Background and objectives: Hypertension is a leading modifiable risk factor for cardiovascular disease in sub-Saharan Africa, but recent data from Liberia are scarce. We estimated the prevalence, awareness, treatment and control of hypertension, and identified associated factors, among adults attending primary care clinics in Montserrado County.

Methods: Facility-based cross-sectional study conducted from March to August 2025.

Subjects, materials, setting and measurements: 1,400 adults aged 18 years or older were recruited by systematic sampling at eight clinics (three urban, three peri-urban, two rural). Participants completed the WHO STEPS questionnaire; blood pressure (mean of two readings), anthropometry, fasting glucose, lipid profile and serum creatinine were measured. Hypertension was defined as blood pressure of 140/90 mmHg or higher, or current antihypertensive treatment.

Results: The mean age was 43.6 years (SD 15.2) and 56.3% were women. The prevalence of hypertension was 36.4% (95% CI 33.9-38.9). Among hypertensive participants, 48.2% were aware of their diagnosis, 31.4% were treated and 14.7% had controlled blood pressure. Older age (aOR 9.9 for 60 years or above versus 18-29 years), obesity (aOR 2.9), diabetes (aOR 2.2) and family history (aOR 1.7) were independently associated with hypertension. Hypertensive participants had higher glucose, LDL cholesterol and creatinine, and lower eGFR (all P < 0.001).

Conclusions: Hypertension is common and poorly controlled in Montserrado County primary care. Screening, reliable access to low-cost medicines and integrated management of cardiometabolic risk should be prioritised, particularly in rural clinics.

Revision (version 2): clinics and participants were selected by systematic sampling with a 91% response rate; analyses used a cluster-robust model (ICC 0.04), and a sensitivity analysis excluding the two rural clinics with fewer than 150 participants gave similar estimates.

Version 3: crude and adjusted odds ratios are now shown side by side in Table 3, the wide interval for the 60+ group is explained, the Discussion was shortened and references 14 and 22 were corrected.