Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis

Background: The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low-and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and metaanalysis to provide updated estimates of paediatric hypertension in Africa. Methods: We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I 2 statistic. Findings: In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (02%-389%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP95th percentile) was 745% (95%CI 530-992, I 2 =98.96%), elevated blood pressure (BP, systolic/diastolic BP90th percentile and <95th percentile) 1138% (95%CI 794-1533, I 2 =98.97%) and combined hypertension/elevated BP 2174% (95%CI 155-2869, I 2 =99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (185% 95%CI 102-285) than those categorized as underweight/normal (10% 95%CI 01-26, 48% 95%CI 29-71, p<0001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines. Interpretation: Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity.