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

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, but recent estimates of prevalence in children are lacking. The association between hypertension and increased body mass index is well known. With rapidly increasing childhood overweight and obesity, updated estimates are important. 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 following the Freeman-Tukey arcsine transformation to stabilize the variance. Heterogeneity was quantified using the I2 statistic. Findings: We included 53 studies in narrative synthesis and 41 in meta-analysis reporting pooled data of 52918 participants 3-19 years from 10 countries. Publication bias was low for 23 studies, moderate for 15, with no high-risk studies. Hypertension prevalence ranged substantially across studies (0·2%-38·9%). The pooled prevalence for hypertension (systolic or diastolic blood pressure (BP) ≥95th percentile) was 7·45% (95%CI 5·30-9·92), elevated BP (systolic or diastolic BP ≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69). Participants categorized as overweight/obese had a significantly higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight or normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). Significant differences in hypertension prevalence were seen when comparing methodology of BP collection (number of measures and measurement occasions, and method of BP collection) and classification guidelines used. Interpretation: When compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, as well as highlighting the potential role of to increasing overweight/obesity. Funding: None. Declaration of Interests: We declare no competing interests.