Hypertension in West Africa: a systematic review and meta-analysis of prevalence and associated risk factors

Abstract

Hypertension remains a critical modifiable risk factor contributing to the global burden of cardiovascular disease. Despite its escalating prevalence in West Africa, comprehensive regional data on its epidemiological patterns and associated determinants remain sparse. This study addresses this gap through a systematic review and meta-analysis, synthesizing existing evidence on hypertension prevalence and its risk factors across West African populations. A comprehensive search was conducted across multiple databases, including PubMed/MEDLINE, Web of Science, Scopus, Embase, CINAHL, and other sources to identify observational studies reporting hypertension prevalence or associated risk factors in adults aged ≥ 18 years in West Africa. Studies were included if they employed standardized diagnostic criteria (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or current antihypertensive medication use). Pooled prevalence estimates and odds ratios (ORs) for key risk factors were derived using random-effects meta-analysis. Heterogeneity was rigorously evaluated through prediction interval (PI), I² statistics, Q-tests, tau-squared, tau, and meta-regression analyses. The analysis included 30 studies comprising 70,212 participants from 10 West African nations. The pooled prevalence of hypertension was estimated at 33.8% (95% CI: 29.3, 38.7%), with substantial heterogeneity (I² = 99.4%; PI = 13 to 63%). Several factors were significantly associated with hypertension risk: overweight status (OR = 1.61; 95% CI: 1.40–1.85; I² = 88.4%; PI: 0.93–2.78), obesity (OR = 2.26; 95% CI: 2.02–2.53; I² = 75.2%; PI: 1.50–3.41), alcohol use (OR = 1.23; 95% CI: 1.05–1.44; I² = 79%; PI: 0.67–2.25), type 2 diabetes mellitus (OR = 1.98; 95% CI: 1.52–2.59; I² = 82.2%; PI: 0.81–4.84), reduced physical activity (OR = 1.46; 95% CI: 1.09–1.94; I² = 78.1%; PI: 0.57–3.70), and a family history of hypertension (OR = 1.74; 95% CI: 1.31–2.32; I² = 52.6%; PI: 0.59–5.18). Smoking showed a marginal association (OR = 1.03; 95% CI: 0.80–1.32; I² = 80.9%; PI: 0.42–2.51). Age demonstrated a strong positive association (β = 0.0537, p < 0.001), explaining 67% of the variance in the meta-regression model. Heterogeneity remained high across all risk factor analyses (I² range: 52.6–88.4%), underscoring variability in regional epidemiological patterns. Combating West Africa’s high hypertension burden requires integrated strategies focusing on lifestyle modification, early detection, and strengthened primary healthcare systems.