Elevated blood pressure levels among 533 167 adults living in Sub-Saharan Africa: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Age-related increase from 10.6% (ages 21-30) to 66.4% (ages 71-80)

• Primary Outcome: Hypertension prevalence: 30.5% (95% CI 28.4-32.6%)

• Nnt Or Sensitivity: Regional variation: Eastern Africa lowest at 27.2% (95% CI 24.8-29.7%)

• Confidence Interval: 95% CI provided for all estimates

Clinical Application

Highlights need for population-level screening and intervention programs Limited direct applicability to Australian population, but relevant for care of Sub-Saharan African migrants and global health initiatives Adults in Sub-Saharan Africa, with potential relevance to similar populations globally

Abstract

AIMS: Synthesizing contemporary data from sub-Saharan African countries, we did a systematic review and meta-analysis of blood pressure (BP) levels and hypertension among adults living in the region. METHODS AND RESULTS: We searched PubMed and other databases to identify studies published from 1 January 2010 to 31 December 2021. We used a random-effects model to estimate the pooled-prevalence of hypertension and mean systolic/diastolic BP overall and on a sex- and age-specific basis. Heterogeneity (I²) was assessed via the χ² test on Cochran's Q statistic. We identified 170 high-quality studies (195 samples) comprising 533 167 adults living in 26 countries. The pooled prevalence of hypertension was 30.5% (95% CI 28.4-32.6%). Overall mean systolic/diastolic BP was 128 (95% CI 127-129)/80 (95% CI 79-80) mmHg, with males recording higher mean BP levels (3.10 [95% CI 2.30-3.90]/0.69 [95% CI 0.10-1.29] mmHg) compared with females. Reflecting increasingly higher BP levels with age, the pooled estimates of hypertension prevalence initially rose three-fold (from 10.6% [95% CI 8.2-13.0%] to 30.9% [95% CI 27.8-34.0%]) in those aged 21-30 to 41-50 years, and then two-fold to 66.4% (95% CI 64.2-68.7%) among those aged 71-80 years, respectively. Hypertension prevalence was lower in healthy weight [28.4% (95% CI 26.1-30.6%)] compared with overweight [35.8% (95% CI 31.4-40.1%)] adults. Regionally, prevalent hypertension was lowest in those living in Eastern Africa [27.2% (95% CI 24.8-29.7%)]. CONCLUSION: Our findings suggest a steep age-related pattern of increasing BP levels in the region that will adversely affect millions of people within the next 10-20 years without urgent intervention. A detailed review and analysis of 170 studies involving more than half a million adult men and women living in 26 sub-Saharan Africa countries, revealed that one in three have elevated blood pressure/hypertension.Elevated blood pressure levels, and the markedly increased risk of suffering a debilitating or fatal cardiovascular event at an early age, rose steeply from around one in ten affected at age 20–30 years to around one in three by the age of 50 years.Beyond the influence of age, the risk of having elevated blood pressure was different, given it increased markedly for overweight men and women, whilst those living in (mainly poorer) Eastern African countries had the lowest blood pressure levels.

References

1. 1.Chen, A., Chan, Y. K., Mocumbi, A. O., Beilby, J., Ojji, D. B., Sliwa, K., Damasceno, A., & Stewart, S. (2026). Elevated blood pressure levels among 533 167 adults living in Sub-Saharan Africa: a systematic review and meta-analysis. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwaf706