Stroke is emerging as a leading cause of preventable death and disability in adults in many developing nations. In Sub-Saharan Africa (SSA), stroke mortality and case fatality in some countries exceed those in the developed world. Stroke also occurs at much earlier ages in SSA, resulting in a greater number of years of potential life lost. The high social and economic burden of stroke calls for effective strategies for prevention, treatment, and rehabilitation in SSA. High blood pressure is the most powerful predictor of stroke, and its treatment can reduce the risk of stroke by > or = 40%. Effective stroke prevention calls for comprehensive risk reduction including blood pressure control. Population-based health education programs and appropriate public health policy coupled with high-risk strategies targeting hypertensive persons and stroke patients must be developed. A broad partnership of key players, innovative funding mechanisms, and increased national and international commitment for the prevention and control of stroke in sub-Saharan Africa and other developing countries is needed.