Hypertension in East Africa: A Systematic Review and Meta-Analysis of Prevalence and Associated Risk Factors

Abstract

Hypertension is a leading modifiable risk factor for cardiovascular disease and premature death worldwide. In East Africa, its burden is increasing, yet estimates remain fragmented across countries, limiting effective regional health planning. We estimate the pooled prevalence of hypertension and identify its major determinants among adult populations in East Africa. We conducted a systematic review and meta-analysis of studies published between January 2007 and December 2024, following PRISMA 2020 guidelines. Databases searched included PubMed, Embase, Scopus, Web of Science, CINAHL, and grey literatures. Studies were eligible if they reported the prevalence or risk factors of hypertension in East African adults. Random-effects model was applied to compute pooled estimates, and heterogeneity was assessed using prediction interval, I², Q-test, tau², and tau. A total of 21 studies involving 56 503 participants from seven East African countries were included. The pooled prevalence of hypertension was 21.0% [95% confidence interval (95% CI): 17.9–24.4, I²: 98.8%]. The risk of hypertension was associated with overweight [odds ratio (OR) = 1.845; 95%: 1.534–2.219, I²: 66.7%], general obesity (OR = 3.045; 95% CI: 2.511–3.693; I²: 90.1%), abdominal obesity (OR = 2.010; 95% CI: 1.443–2.800; I²: 97.6%), alcohol consumption (OR = 1.232; 95% CI: 1.005–2.011; I²: 80.8%), tobacco smoking (OR = 1.479; 95% CI: 1.130–1.935; I²: 83.7%), and diabetes (OR = 2.458; 95% CI: 1.362–4.437; I²: 95.7%). In conclusion, hypertension affects nearly one in four adults in East Africa. Overweight, obesity, general obesity, WHR, T2DM, and age are associated with onset of hypertension.