Elevated blood pressure among adolescents in sub-Saharan Africa: a systematic review and meta-analysis

Background More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries. However, there is a paucity of data on the pattern of elevated blood pressure among adolescents aged 10-19 years in sub-Saharan Africa. We aimed to provide pooled estimates of high blood pressure prevalence and mean levels in adolescents aged 10-19 years across sub-Saharan Africa.Methods In this systematic review and meta-analysis, we searched PubMed, Google Scholar, African Index Medicus, and Embase to identify studies published from Jan 1, 2010, to Dec 31, 2021. To be included, primary studies had to be observational studies of adolescents aged 10-19 years residing in sub-Saharan African countries reporting the pooled prevalence of elevated blood pressure or with enough data to compute these estimates. We excluded studies on non-systemic hypertension, in African people not living in sub-Saharan Africa, with participant selection based on the presence of hypertension, and with adult cohorts in which we could not disaggregate data for adolescents. We independently extracted relevant data from individual studies using a standard data extraction form. We used a random-effects model to estimate the pooled prevalence of elevated blood pressure and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels overall and on a sex-specific basis. This study is registered with PROSPERO (CRD42022297948).Findings We identified 2559 studies, and assessed 81 full-text studies for eligibility, of which 36 studies comprising 37 926 participants aged 10-19 years from ten (20%) of 49 sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. Sex data were available from 26 818 adolescents (14 369 [53<middle dot>6%] were female and 12 449 [46<middle dot>4% ] were male) for the prevalence of elevated blood pressure and 23 777 adolescents (12 864 [54<middle dot>1%] were female and 10 913 [45<middle dot>9%] were male) for mean blood pressure. Study quality was high, with no low-quality studies. The reported prevalence of elevated blood pressure ranged from 4 (0<middle dot>2%) of 1727 to 1755 (25<middle dot>1%) of 6980 (pooled prevalence 9<middle dot>9%, 95% CI 7<middle dot>3-12<middle dot>5; I-2=99<middle dot>2%, p(heterogeneity)<0<middle dot>0001). Mean SBP was 111 mm Hg (95% CI 108-114) and mean DBP was 68 mm Hg (66-70). 13<middle dot>4% (95% CI 12<middle dot>9-13<middle dot>9; p(heterogeneity)<0<middle dot>0001) of male participants had elevated blood pressure compared with 11<middle dot>9% (11<middle dot>3-12<middle dot>4; p(heterogeneity)<0<middle dot>0001) of female participants (odds ratio 1<middle dot>04, 95% CI 0<middle dot>81-1<middle dot>34; p(heterogeneity)<0<middle dot>0001).Interpretation To our knowledge, this systematic review and meta-analysis is the first systematic synthesis of blood pressure data specifically derived from adolescents in sub-Saharan Africa. Although many low-income countries were not represented in our study, our findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. Accordingly, there is an urgent need to improve preventive heart-health programmes in the region.