Prevalence and associated factors of hypertension among adults in Sub-Saharan Africa: a systematic review and meta-analysis of community-based studies

Hypertension (HT) is a major global public health challenge, responsible for more than 10 million deaths annually. In sub-Saharan Africa (SSA), its prevalence is high and rising, driven by rapid urbanisation, nutritional transition, and increasing sedentary behaviour, while screening and control rates remain suboptimal. This systematic review and meta-analysis aimed to estimate the prevalence of HT among adults in SSA and identify its key associated factors. The protocol was registered in PROSPERO (CRD420251021429) and conducted in accordance with PRISMA 2020. We included cross-sectional studies published between January 2010 and November 2025, involving adults (≥ 18 years) and defining HT according to JNC7. Searches were conducted across seven databases and grey literature. Methodological quality was assessed using Joanna Briggs Institute tools (threshold ≥ 50%). A random-effects meta-analysis was performed using Stata 16. Of 11,895 records screened, 52 studies were included. The pooled prevalence of HT was 27.09% (95% CI: 24.22%–29.96%; I² = 99.5%). Regional estimates ranged from 22.43% in Southern Africa to 32.75% in Central Africa. Major factors associated with HT included age > 50 years, which conferred nearly a fivefold increased risk (OR = 4.93; 95% CI: 3.61–6.72), male sex (OR = 1.80; 95% CI: 1.14–2.84), diabetes mellitus (OR = 4.01; 95% CI: 2.88–5.58), abdominal obesity (OR = 2.86; 95% CI: 2.33–3.52), overweight/obesity (OR = 2.72; 95% CI: 2.26–3.28), alcohol consumption (OR = 1.97; 95% CI: 1.57–2.46), smoking (OR = 1.69; 95% CI: 1.44–1.97), physical inactivity (OR = 1.60; 95% CI: 1.36–1.89), low fruit and vegetable intake (OR = 1.42; 95% CI: 1.16–1.75), urban residence (OR = 1.21; 95% CI: 1.08–1.35), and a family history of HT (OR = 2.37; 95% CI: 1.66–3.38). Occupational status was not significantly associated with HT (OR = 1.21; 95% CI: 0.76–1.93). More than one in four adults in SSA is hypertensive, with substantial regional disparities. Most identified determinants are modifiable, underscoring the urgent need for strengthened primary prevention through healthier lifestyles, community-based screening, and integrated management of metabolic disorders. Context-specific strategies are essential to curb this silent epidemic and reduce the cardiovascular burden across the region.