Trends of age-standardised hypertension prevalence, treatment, and control among adults aged 30–79 years in Africa from 1990 to 2019

Abstract

Background High blood pressure is a leading modifiable risk factor for cardiovascular disease and premature death worldwide. We aimed to assess three-decade trends in hypertension prevalence, diagnosis, treatment, and control among adults in Africa. Methods We conducted a secondary analysis of age-standardised data from the WHO Health Inequality Data Repository, covering 54 African countries from 1990 to 2019. Trends in hypertension prevalence, treatment uptake, and control rates were analysed among adults aged 30–79 years using the Cox–Stuart test. Results were stratified by sex and by the WHO African subregions: Northern, Western, Central, Eastern, and Southern Africa. Findings The Africa-wide hypertension prevalence rates were higher in females than males and changed modestly over time (males 35.8% in 1990, 38.0% in 2008, 35.0% in 2019; females 36.7%, 39.9%, 38.8%). In 2019, prevalence was highest in Southern Africa for females (42.3%) and in Northern Africa for males (37.3%). Treatment improved continent-wide (males 7.0%→22.3%; females 12.9% → 32.5% from 1990 → 2019). Hypertension control rates increased but remained low (males 1.7% → 9.2%; females 2.9% → 14.2%). No subregion exceeded 20% control in 2019. Females had higher treatment and control rates than males in every subregion. Diagnosis rates improved in the 2000s but remained low in many countries until 2019. Interpretation Hypertension control in Africa lags behind gains in treatment, with <20% of adults with hypertension achieving BP < 140/90 mm Hg by 2019. These findings underscore an urgent need for scalable, context-specific strategies to expand access to diagnosis, affordable medication, and effective care delivery. Strengthening hypertension control is essential to curbing the rising burden of cardiovascular disease across Africa. Funding Support for analysis staff was provided by the Alliance for Medical Research in Africa (AMedRA), the Office of the Provost, Faculty Development and Leadership Advancement, the University Centre for International Studies, and the Centre for African Studies at the University of Pittsburgh.