Paediatric hypertension in Africa: a systematic review and meta-analysis
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 meta-analysis 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 I2 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 (0·2%-38·9%). 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 BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). 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.
Funding: this research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
Paediatric, Hypertension, Blood pressure, Africa, child and adolescent
Crouch, Simone H.
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Soepnel, Larske M.
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Kolkenbeck-Ruh, Andrea
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Maposa, Innocent
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Naidoo, Sanushka
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Davies, Justine
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Norris, Shane A.
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Ware, Lisa J.
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January 2022
Crouch, Simone H.
a392e867-3a5f-4323-9deb-6198c9535d66
Soepnel, Larske M.
5a89deee-06a8-4a04-b4e6-cae60b0350f1
Kolkenbeck-Ruh, Andrea
3e7433c8-e1ea-48ac-9243-f299f321daf8
Maposa, Innocent
1a4e7044-6174-41ff-98c6-c8ac60a52b77
Naidoo, Sanushka
672c4f4f-6b7b-4891-a70b-278101aa1493
Davies, Justine
b6e1f255-19ef-4150-93c4-9fd4de80b340
Norris, Shane A.
1d346f1b-6d5f-4bca-ac87-7589851b75a4
Ware, Lisa J.
74860e6c-ac74-44ae-bb62-a7a2032852ba
Crouch, Simone H., Soepnel, Larske M., Kolkenbeck-Ruh, Andrea, Maposa, Innocent, Naidoo, Sanushka, Davies, Justine, Norris, Shane A. and Ware, Lisa J.
(2022)
Paediatric hypertension in Africa: a systematic review and meta-analysis.
EClinicalMedicine, 43, [101229].
(doi:10.1016/j.eclinm.2021.101229).
Abstract
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 meta-analysis 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 I2 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 (0·2%-38·9%). 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 BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). 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.
Funding: this research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
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Submitted date: 3 September 2021
Accepted/In Press date: 22 November 2021
e-pub ahead of print date: 6 December 2021
Published date: January 2022
Keywords:
Paediatric, Hypertension, Blood pressure, Africa, child and adolescent
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Local EPrints ID: 504433
URI: http://eprints.soton.ac.uk/id/eprint/504433
ISSN: 2589-5370
PURE UUID: c84fdb90-b55f-4ec5-abf4-6306dd3d369c
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Date deposited: 09 Sep 2025 17:46
Last modified: 11 Sep 2025 03:09
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Contributors
Author:
Simone H. Crouch
Author:
Larske M. Soepnel
Author:
Andrea Kolkenbeck-Ruh
Author:
Innocent Maposa
Author:
Sanushka Naidoo
Author:
Justine Davies
Author:
Lisa J. Ware
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