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

Simone H Crouch; Larske M Soepnel; Andrea Kolkenbeck-Ruh; Innocent Maposa; Sanushka Naidoo; Justine Davies; Shane A Norris; Lisa J Ware

doi:10.1016/j.eclinm.2021.101229

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

EClinicalMedicine. 2021 Dec 6:43:101229. doi: 10.1016/j.eclinm.2021.101229. eCollection 2022 Jan.

Authors

Simone H Crouch¹, Larske M Soepnel^{1

2}, Andrea Kolkenbeck-Ruh¹, Innocent Maposa³, Sanushka Naidoo¹, Justine Davies^{1

4}, Shane A Norris^{1

5}, Lisa J Ware^{1

6}

Affiliations

¹ SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
² Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
³ Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa School of Public Health.
⁴ Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
⁵ School of Health and Human Development, University of Southampton, Southampton, United Kingdom.
⁶ DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.

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.

Keywords: Africa; BMI, Body mass index; BP, Blood pressure; Blood pressure; CVD, Cardiovascular disease; Child and adolescent; GDP, Gross domestic product; Hypertension; LMIC, Low- and middle-income countires; NCD, Non-communicable diseases; Paediatric; UN, United Nations; WHO, World Health Organisation.