Trends of age-standardized hypertension prevalence, treatment, and control among adults aged 30-79 years in Africa from 1990 to 2019

Abstract Background Hypertension poses a significant global public health challenge, affecting about 1.28 billion people worldwide, two-thirds of whom live in low- and middle-income countries. However, reliable epidemiological data is lacking in African settings despite an urgent need to understand local trends to tackle this burden. Objective To analyze trends over three decades in the age-standardized prevalence of hypertension, treatment, and control across 54 African countries within five World Health Organization (WHO)-defined African regions: East, Central, West, North, and Southern. Methods We used publicly available WHO Health Inequality Repository data. Using the Cox-Stuart test for trend, we compared trends of age-standardized hypertension prevalence, treatment, and control among adults aged 30-79 in the different African regions from 1990 to 2019 stratified by sex. We also calculated the percentage change over time for each region. Results From 1990 to 2008, hypertension prevalence in Africa increased by an average of 6.2% in males and by 8.8% in females. From 2008 to 2019, it decreased by 7.9% in males and 2.9% in females. In 2019, rates among males were highest in North Africa (37.3%), while Southern African females had the highest rates (42.3%). The highest rates of change were observed for the 1990-2008 increase among Southern African females (14.2%) and the 2008-2019 decrease among males in East Africa (12%). Hypertension treatment rates from 1990 to 2019 increased persistently in general on the continent, with rates in males tripling (from 7.0% to 22.3%) while they more than doubled in females (from 12.9% to 32.5%), p-value 0.001 in both cases. The highest treatment rates for males and females were in North Africa (26.5% and 41.9% respectively in 2019). The highest rates of increase in treated hypertension were seen in West African males (259.8%) and Central African females (174.5%). Controlled hypertension increased in all regions from 1990 to 2019, with all trends statistically significant (p-value 0.001). The highest rates of increase in controlled hypertension were observed in Southern African males (537.1%) and East African females (439.4%). Conclusion The present study identifies region-specific differences in hypertension prevalence, with Southern Africa exhibiting the highest rates. Treatment rates for hypertension increased over time in all regions, but control rates remained substantially low (less than 20% across all regions), indicating wide treatment gaps. The need for continuous monitoring is underscored, as it is essential for informing appropriate strategies to improve these trends and address the significant public health burden of hypertension.