Prevalence and Determinants of Cardiovascular Disease Among Hypertensive Adults in Saudi Arabia: A Cross-Sectional Evaluation of Lifestyle and Clinical Risk Factors

Background/Objectives: Cardiovascular disease (CVD) represents a leading source of morbidity and mortality among individuals with hypertension; however, locally relevant evidence on the determinants of CVD risk within hypertensive populations in Saudi Arabia remains limited. This study aimed to identify independent sociodemographic, lifestyle, dietary, anthropometric, clinical, and hereditary determinants of self-reported CVD among hypertensive adults. Methods: This cross-sectional study included 444 adults with a prior physician-confirmed diagnosis of hypertension. Cardiovascular disease (CVD) status was determined by self-report. Bivariate comparisons were performed between participants with and without CVD, followed by multivariable logistic regression to identify factors independently associated with CVD. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: The mean age was 49 years (SD ± 15) and CVD was reported by 10.8% of participants. In bivariate analysis, CVD was significantly associated with urban residence, unemployment, larger family size, lower whole grain consumption, ex-smoking status, and the presence of diabetes mellitus and a family history of CVD. In the fully adjusted model, family history of CVD was the strongest independent predictor (adjusted OR = 17.70; 95% CI: 7.68–44.46; p < 0.001), followed by diabetes mellitus (adjusted OR = 5.28; 95% CI: 1.98–15.46; p = 0.001). Whole grain consumption was independently protective (adjusted OR = 0.34; 95% CI: 0.14–0.79; p = 0.016), and dyslipidaemia demonstrated a borderline positive association (adjusted OR = 2.69; 95% CI: 0.93–7.40; p = 0.059). Conclusions: Family history of CVD and diabetes mellitus were the strongest independent determinants of CVD among hypertensive adults in Saudi Arabia, while whole grain intake emerged as a practical and modifiable dietary protective factor. These findings support the integration of family-history-informed risk stratification, coordinated cardiometabolic management, and culturally adapted dietary counselling into routine hypertension care.