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 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-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 3-19 from 10 countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated 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/obese 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, as well as highlighting the potential role of to increasing overweight/obesity.
Funding: This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. For the purpose of Open Access, we applied a CC-BY public copyright licence to any Author Accepted Manuscript version arising from this submission. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
Methods: We searched PubMed and EBSCO to identify articles published from January 2017-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 3-19 from 10 countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated 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/obese 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, as well as highlighting the potential role of to increasing overweight/obesity.
Funding: This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. For the purpose of Open Access, we applied a CC-BY public copyright licence to any Author Accepted Manuscript version arising from this submission. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
| Original language | English |
|---|---|
| Article number | 101229 |
| Journal | EClinicalMedicine |
| Volume | 43 |
| Early online date | 3 Dec 2021 |
| DOIs | |
| Publication status | Published - Jan 2022 |
Keywords
- Africa
- Paediatric
- blood pressure
- child and adolescent
- hypertension
