Prevalence of hypertension in Africa in the last two decades: systematic review and meta-analysis

Despite being the most common cardiovascular risk factor, the actual burden of hypertension is poorly characterized in Africa. We meta-analysed the most extensive pooled data to determine the overall prevalence of hypertension in Africa. Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically searched Google Scholar, PubMed, ScienceDirect, and Web of Science databases to retrieve prevalence studies only on hypertension among Africans published between 2002 and 2023. Furthermore, we meta-analysed the crude and age-adjusted prevalences of hypertension using a random effect model due to the expected high heterogeneity, with logit transformation of the original proportions. Seventy-eight (out of an initial 779 screened) articles with complete data were included, with a total number of hypertension cases of 71 004 and a denominator population of 286 575, mostly from community-based studies in 23 countries. The pooled crude prevalence of hypertension was 28.5/100 persons 95% confidence interval (CI): 25.3-31.8% and a 95% prediction interval of 7.6-65.6%; the pooled prevalence increased with age and was highest among the aged ≥75 years: 51.4% (95% CI: 42.0-60.6%) and remained highest in the Southern Africa region overall (34.8%) and in the last decade (2013-23; 44.5%). The point estimate of the pooled crude prevalence was higher among urban dwellers, 32.9% (95% CI: 26.8-39.5%), than rural residents, 26.3% (95% CI: 20.4-33.3%). In a subset of 21 articles reporting age stratification consistent with the World Health Organization standard population, the pooled age-standardized prevalence was 27.2/100 persons (95% CI: 20.9-33.6%). The burden of hypertension remains high, especially in urban areas and with increasing age. Frequent screening and treatment are recommended, especially in urban areas.