Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities

Abstract

Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.

Fig. 1. Inclusion of rural areas in multinational studies assessing hypertension prevalence in sub-Saharan Africa.

This figure depicts the two major recent multinational studies (H3Africa AWI-Gen; SevenCEWA) that presented data on hypertension prevalence, awareness, treatment, and control in rural and urban areas of sub-Saharan Africa. The green and orange colors show the included countries, while grey represents countries not included in the two studies. The orange star indicates that the country was included in both studies. H3Africa Human Heredity and Health in Africa, SevenCEWA seven communities in East and West Africa.

Fig. 2. Recent multinational and country-specific studies assessing hypertension prevalence, treatment and control in sub-Saharan Africa.

This figure depicts recent (2017–2023) prevalence, treatment and control rates reported in nationwide and regional (within country) surveys in sub-Saharan Africa. Where multiple surveys are available for the 2017–2023 period, the most recent one is presented. SSA sub-Saharan Africa.