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Background: Globally, hypertension is still a major contributor to disability and mortality. The prevalence of hypertension is predicted to increase over time. Indonesia has the highest prevalence of hypertension among the South East Asia countries. However, there is no study investigating the factors associated with the incidence of hypertension in Indonesia using longitudinal data. This study aims to investigate the incidence of hypertension and to assess the determinants associated with the development of hypertension among adult Indonesian population.

Methods: This study utilized the panel data from two waves of Indonesian Family Life Survey study (IFLS-4 in 2007/2008 and IFLS-5 in 2014/2015). A total of 18,579 individuals aged 15 and over who participated in both IFLS-4 and IFLS-5 with complete biological, demographic, and socioeconomic information were analysed. For the purpose of this study, we only followed respondents who did not have hypertension at the baseline (IFLS wave 4), a total of 15,645 individuals (84.2% of IFLS-4 participants), during a 7-year follow up period. We examined their hypertension status in 2014/2015. We used random effects model to analyse the determinants associated with the development of hypertension. We controlled for sociodemographic factors, smoking behaviour, body mass index, and mental health status, as well as socioeconomic status which was developed using Principal Component Analysis (PCA).

Results: A total of of 5,552 (29.9%) were hypertensive in IFLS-5. The annual incidence rate of hypertension was 239.6 per 10,000 people. There was no significant association between socioeconomic status and the development of hypertension status (p>0.05), after controlling for other sociodemographic and biological factors. But being older (p<0.05), men (OR: 1.2, 95%CI: 1.05 - 1.38), overweight (OR: 2.23 95%CI: 2.02 - 2.47), obese (OR: 4.14, 95%CI: 3.6 - 4.76), as a former smoker (OR: 1.43, 95%CI: 1.14 - 1.8), and being widow/divorcee (OR: 1.43, 95%CI: 1.14 - 1.80) were significantly associated with higher odds of developing hypertension. In contrast, being an underweight individual (OR: 0.54, 95%CI:0.45 - 0.64) and categorised in 2nd tertile of mental health (OR:0.83, 95%CI: 0.75 - 0.92) lowered the odds of developing hypertension. Education level, working status, and residence area were not significantly associated with the development of hypertension.

Conclusion: The incidence of hypertension in Indonesia is high. This finding indicates the need for programmes and policies aiming to reduce the incidence of hypertension. The attention should be given to all individual regardless their socioeconomic groups. Further research need to elaborate the underlying mechanisms behind the development of hypertension among the adult population.