Home | Volume 54 | Article number 108

Systematic review and meta-analysis

Paediatric hypertension in Nigeria (2000 - 2025): a systematic review and meta-analysis

Paediatric hypertension in Nigeria (2000 - 2025): a systematic review and meta-analysis

Kevin Bassey1,&, Olumuyiwa Folayan2, Ifunanya Ebiekpi1

 

1Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria, 2Department of Paediatrics, University College Hospital, Ibadan, Nigeria

 

 

&Corresponding author
Kevin Bassey, Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria

 

 

Abstract

The prevalence of paediatric hypertension appears to be increasing in Nigeria and other low- and middle-income settings, although available evidence remains limited and heterogeneous. Hypertension is the leading modifiable risk factor for cardiovascular disease (CVD), and early-life control of blood pressure is critical for reducing adult disease burden. This review aimed to determine the prevalence and associated risk factors of hypertension among Nigerian children between 2000 and 2025. A systematic search of MEDLINE, EBSCO, African Journals Online, Cochrane Library, and Google Scholar was conducted for studies published between January 2000 and September 2025. Eligible studies reported the prevalence and/or risk factors of hypertension in individuals aged <19 years. Random-effects meta-analysis was performed. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated using Egger's regression test. Forty-nine studies (n = 51,283) were included, of which 38 were pooled in the meta-analysis. The pooled prevalence of hypertension (n = 38) (blood pressure (BP) ≥95th percentile for age, sex, and height) was 4.78% (95% CI 3.89-5.85%; I2 = 95.9%), and 7.86% (95% CI 5.52-11.08%; I2 = 98.2%) for pre-hypertension elevated blood pressure (BP 90th-94th percentile) (n = 24). Overweight and obesity were the most consistently reported risk factors across studies. A gender meta-analysis demonstrated a higher observed prevalence of hypertension among females compared to males (risk ratio 1.37, 95% CI 1.13-1.66; Z = 3.25, P < 0.001) (n = 26), with moderate heterogeneity (I2 = 66.65%). Egger's test suggested small-study effects in the primary analysis (P < 0.001). Paediatric hypertension in Nigeria represents a substantial and potentially increasing public health concern. However, very high heterogeneity across studies limits the precision of pooled estimates. Standardized diagnostic approaches and well-designed longitudinal studies are needed to better define the burden and inform effective prevention strategies.

 

 

Introduction    Down

It is now known that non-communicable diseases (NCDs) cause 71% of all global deaths and 14.9% of all deaths in the paediatric age group [1], and an estimated 80% of these NCD-related deaths occur in LMICs [2]. Current evidence suggests that NCDs, such as cardiovascular disease, can be effectively prevented/reversed if such prevention begins in childhood [3]. Approaches to preventive efforts addressing NCDs and their risk factors that begin during childhood and adolescence may be the best option for reducing the long-term global burden of disease [4].

Hypertension is the most important factor driving the recent increase in prevalence of NCDs, being the major risk factor for cardiovascular disease [5]. It is also known that hypertension in childhood predicts worse outcomes for cardiovascular disease in adulthood and that risk factors for adult cardiovascular disease may be mitigated by interventions started in childhood [6,7].

Recent studies and reviews have shown that the prevalence of childhood hypertension is increasing worldwide, including low- and middle-income countries [8]. Earlier reviews from Africa have given a prevalence of hypertension in children of between 4 and 7.5%, with the prevalence significantly increased in overweight and obese children [5,9,10]. The only other published review from Nigeria gave a prevalence of 5.1% for hypertension and 8.2% for pre-hypertension [5] while observing a slight negative trend in the prevalence.

These findings make it imperative that elevated blood pressure and hypertension be identified and characterized in Nigerian children to provide evidence for the implementation of large-scale interventions to reduce risk factors for cardiovascular disease and reverse the trend towards increasing burden of NCDs in the country.

Using the population, exposure, outcome (PEO) model, this review seeks to answer the following questions: "what is the prevalence of hypertension in Nigerian children, and what risk factors are associated with hypertension in Nigerian children?" This review aimed to estimate the prevalence and identify risk factors for hypertension among Nigerian children and adolescents between 2000 and 2025.

 

 

Methods Up    Down

This systematic review was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) [11], and the PRISMA flow diagram of the search process generated for the study is shown below in Figure 1, and a full PRISMA checklist is provided as a supplement.

A comprehensive literature search was carried out for articles published between January 2000 and September 2025. Studies included in the review were published and indexed articles in peer-reviewed journals that studied the prevalence and risk factors of paediatric hypertension in Nigerian children. Commentaries, editorials, case reports, and qualitative or mixed-methods studies were excluded. Studies done among people less than 19 years of age were included; adult studies and studies among people of all ages were excluded. Only studies published in the English language were included. The systematic review protocol was registered with OSF.

Search strategy: literature search was conducted across the following databases - MEDLINE, EBSCO (Global Health), Google Scholar, African Journals Online and the Cochrane Database of Systematic Reviews using relevant Medical Subject Headings (MESH) keywords and Boolean connectors.

Keywords and phrases used included: "hypertension", "elevated blood pressure", "NCDs", "Nigerian," "Nigerian children", "Nigerian adolescents", "risk factors", "interventions". Boolean operators such as 'AND' and 'OR' were applied to broaden the search. The operator 'NOT' was used to exclude adult articles. Specific risk factors such as "physical inactivity", "dyslipidaemia", "overweight/obesity" were included in search terms. Reference lists of identified articles were also searched to identify additional relevant articles.

For MEDLINE, the search strings applied were : ("Hypertension"[MESH] OR "high blood pressure" OR "elevated blood pressure") AND ("Child"[MESH] OR "Adolescent"[MESH] OR children OR adolescents OR paediatric OR pediatric) AND ("Nigeria" OR Nigerian). The filters applied were for Language: English and for Publication date: January 2000 - September 2025. Similar search strings and keywords were applied to the other databases. For Google Scholar, the first 200. Additional search methods included manual screening of reference lists of included articles to identify further relevant studies. A detailed database search strategy is provided as Annex 1.

Screening and selection: the results were screened for duplicates, which were subsequently removed. This was followed by title and abstract screening, which was completed by the lead researcher (KB), with 10% of titles and abstracts being additionally screened by a second member of the research team (IU). Inter-rater agreement, as measured by Cohen's Kappa, was 0.89, showing almost perfect agreement (P < 0.001). Full texts of eligible articles were then accessed for full-text screening. All full-text articles were double-screened independently by two of the three authors. Conflicts were resolved by the third author.

Risk of bias assessment: the Newcastle-Ottawa quality assessment scale, adapted for cross-sectional studies, was used to assess the quality of included studies and to assess their risk of bias [12]. Scores of the studies are included in the data summary, and a full analysis is included as Annex 1.

Data analysis: data and information from publications that met the inclusion criteria were extracted into a standardized form. Key variables regarding authors, study period, sample size and target population, study design, risk factor descriptions and prevalence were extracted and presented in data summary tables in the results section.

The prevalence was pooled using a random-effects model meta-analysis to provide a single summary estimate. For relative risk estimates, odds ratios and risk ratios were considered as equivalent measures. Pooled estimates were provided along with calculated 95% confidence intervals. For the purposes of the meta-analysis, only studies defining elevated BP as BP ≥90th but <95th percentile and hypertension as BP ≥ 95th percentile for age, sex, and height were included. The assessment of between-study heterogeneity was done using I2 statistics. Subgroup analysis and meta-regression was performed in case of significant heterogeneity, comparing the following pre-determined variables: age (adolescents and younger children), sex, standards used for categorization of hypertension (for example, the AAP 2004 - Fourth Report; the AAP Clinical Practice Guidelines 2017 guidelines), sample size (<1000 vs >1000), year of publication, method of BP measurement and risk of bias. Publication bias was assessed using the Egger regression test P value for funnel-plot asymmetry. Analyses were performed in R using the metafor package.

Ethical considerations: as a systematic review and meta-analysis without original data collection, this study was exempt from ethical approval. To the knowledge of the authors, all included studies obtained ethical approval from their respective institutions.

 

 

Results Up    Down

The 49 studies included in this review were published between January 2000 and September 2025. The sample sizes of the included studies ranged from 195 to 2,694, and the cumulative sample size was 51,283. The age range of participants in the included studies was 2-19 years; however, 63% of all the included studies were performed exclusively among adolescents. Most of the studies were mixed gender; only one (2%) was performed exclusively among male adolescents. About three-quarters (75.5%) of the studies were carried out in Southern Nigeria, while 24.5% were from Northern Nigeria. Forty-one of the 49 included studies (83.7%) were assessed to have a low risk of bias (Newcastle-Ottawa Score 7-9), while the rest (16.3%) were assessed to have a moderate risk of bias (Newcastle-Ottawa score 5-6). None of the studies included had a high risk of bias. The commonest shortcoming of included studies was their failure to account for non-response participants and non-documentation of sample size determination.

The reported prevalence of elevated BP ranged from 1.6-47.3% for pre-hypertension, and 0.4-24.8% for hypertension in the children studied. Table 1 gives a summary of the characteristics of the studies included and their main results. The highest prevalence was recorded in a study by Owoeye et al. [13] among a group of male adolescent athletes. However, of the 30 studies reporting on gender, only four [14-17] found that the prevalence of elevated BP was higher in males than females, with 22 reporting a higher prevalence in females [18-39] and five [40-44] reporting no gender differences in hypertension prevalence. Only one study [19] investigated the presence of hypertensive heart disease by echocardiography in children with elevated BP. The study found that none of the children had evidence of hypertensive heart disease. Increasing weight, body mass index (BMI), or overweight/obesity were found to be predictors of elevated BP in 23 studies [14,15,18,23-25,29,32-34,36,38-40,42,44-51]. Not all studies [52-61] reported a clear relationship with gender or anthropometric variables.

Thirty-six of the studies applied the fourth report for the evaluation of BP in children and adolescents [62], five applied the 2017 AHA/AAP CPG [63] for BP in children and adolescents, while three of the earliest studies applied the second task force criteria [64]. Adult BP criteria were applied in two studies: BP > 2SD in one study and the criteria used was not explicitly stated in one study. One study applied the ESH 2016 criteria. The auscultatory method was used in 38 studies (77.6%), while the oscillometric method was used in seven (14.3%). The method used was not stated in three studies (6.1%), while both methods were used in one (2%). Measurements on multiple occasions were used to diagnose elevated BP and hypertension in only 12.2% of studies (Table 2).

A meta-analysis of 38 of the studies included yielded a pooled hypertension prevalence of 4.78% (95% CI 3.89-5.85%), with substantial heterogeneity (I2 = 95.9%; P < 0.001). The pooled pre-hypertension/elevated BP prevalence was 7.86% (95% CI 5.52-11.08%), also with considerable heterogeneity (I2 = 98.2%; P < 0.001) (Figure 2, Figure 3). Egger's test suggested small-study effects for both hypertension (P < 0.001) and pre-hypertension (P < 0.001) (Figure 4), although these should be interpreted cautiously given the substantial between-study heterogeneity. The gender subgroup analysis demonstrated a significantly higher prevalence of hypertension among females compared to males (RR = 1.37, 95% CI 1.13-1.66; Z = 3.25, P < 0.001) (Figure 5). Between-study heterogeneity was moderate to substantial (I2 = 66.7%) for the gender subgroup analysis. Egger's test did not indicate evidence of small-study effects in the gender meta-analysis (p = 0.786). Other subgroup analyses were conducted to explore potential sources of heterogeneity across studies restricted to those applying the fourth report, ESH 2016, or AAP CPG criteria. For hypertension, subgroup analyses by age group showed a higher prevalence (5.68%; 95% CI: 4.29-7.48) in studies conducted exclusively among adolescents than in studies of younger children (3.70%; 95% CI: 2.66-5.13%), and heterogeneity remained high (I2 > 90%). The test for subgroup difference was not significant (p = 0.05). Subgroup analyses of diagnostic criteria applied, publication period, sample size, and risk of bias likewise demonstrated some variation in pooled prevalence estimates; however, heterogeneity remained consistently high across all subgroups (I2 > 84%). Additional subgroup analyses based on methodological characteristics, including method of blood pressure measurement and whether repeat measurements were performed, similarly showed variability in prevalence estimates without a meaningful reduction in heterogeneity. A comparable pattern was observed for pre-hypertension, where subgroup-specific estimates varied modestly, but substantial heterogeneity persisted across all strata (I2 > 90%) (Table 3). Meta-regression analysis was performed to investigate the influence of study-level variables on between-study heterogeneity. Covariates included publication year, sample size, Newcastle-Ottawa scale score, age group, diagnostic criteria, risk of bias, method of blood pressure measurement, and repeat measurement status. Meta-regression showed that none of the examined covariates demonstrated consistent or statistically significant associations with prevalence estimates (Table 4). A significant effect (p = 0.023) was noted on meta-regression of BP criteria applied for the only study that applied the ESH 2016 criteria. However, the overall test for moderator effect was not significant (p = 0.62) and heterogeneity remained significant (I2 = 95%).

Overall, neither subgroup analyses nor meta-regression were able to meaningfully explain the high degree of heterogeneity observed across studies, and these findings suggest that heterogeneity is likely driven by multiple interacting factors rather than a single dominant study-level characteristic.

Other risk factors identified in the included studies were family history of hypertension in five studies [19,31,32,43,54], sedentary lifestyle in two studies [21,31] and the use of alcohol and tobacco in one study [31].

 

 

Discussion Up    Down

Elevated blood pressure remains the strongest modifiable risk factor for cardiovascular disease [65], and childhood hypertension has been consistently associated with adult hypertension and long-term adverse cardiovascular outcomes.

Most studies included in this review reported prevalence estimates that were higher than those reported in a recent global systematic review [8], which found pooled prevalences of 4% for hypertension and 9.67% for pre-hypertension among children worldwide. In the present review, the pooled prevalence of hypertension was slightly higher, while the estimate for pre-hypertension was lower than the global estimate. Similarly, a systematic review conducted in Nigeria approximately a decade ago reported a hypertension prevalence of 5.1% [5], which is fairly consistent with the current finding. A 2022 review among African children reported higher pooled estimates for both hypertension and pre-hypertension than the current study [9]. This difference may, however, reflect the effect of other African regions in the estimate, as the pooled prevalence reported in this study was broadly comparable to that reported for the West African sub-region in the 2022 review (6%). Conversely, an earlier Africa-wide review [10] reported a similar, albeit slightly higher, pooled prevalence for hypertension (5.5%) to the current study.

Previous reviews conducted among Nigerian and African children did not demonstrate significant gender differences in hypertension prevalence [5,9,10]. In contrast, the current analysis found that several individual studies reported higher prevalence among females, and the pooled gender meta-analysis demonstrated a higher observed prevalence in females compared to males (RR = 1.37, 95% CI 1.13-1.66; P < 0.001). This finding may reflect evolving epidemiological patterns, as earlier Nigerian data did not demonstrate such differences [5]. Conversely, reports from North American studies have reported a higher risk of hypertension among boys compared to girls [63], suggesting that regional socio-cultural, behavioural, or biological differences may influence observed gender patterns. However, this observed association should be interpreted cautiously, as the included studies were predominantly cross-sectional and did not adjust for potential confounders such as body mass index, pubertal status, or socioeconomic factors.

Overweight and obesity were identified as predictors of hypertension in a substantial proportion of the included studies, consistent with previous reviews [5,8-10] and the well-established relationship between adiposity and elevated blood pressure [66]. These findings reinforce the importance of primary prevention strategies targeting childhood obesity. Interventions focusing on optimal maternal and early childhood nutrition, school-based feeding programmes, and promotion of regular physical activity are likely to be critical in mitigating the growing burden of hypertension in children.

The findings of this review indicate that paediatric hypertension represents a significant and potentially increasing public health concern in Nigeria. Given that the most effective interventions for non-communicable diseases are those initiated early in life, these results provide strong support for the implementation of large-scale preventive strategies targeting children and adolescents, like those adopted in high-income settings [67-69]. Such approaches have not yet been widely implemented in Nigeria. The current national policy and strategic plan of action on prevention and control of non-communicable diseases focuses primarily on adult populations, with limited emphasis on children and adolescents [70]. Furthermore, there are currently no large-scale screening or intervention programmes specifically targeting paediatric populations. There is an urgent need to revise existing policies to incorporate children and adolescents into national NCD prevention frameworks. In addition, international partners and multilateral funding agencies supporting sustainable development goals should ensure that paediatric populations are explicitly included in intervention strategies.

The overall prevalence estimates from this review should be interpreted with caution due to the substantial heterogeneity observed across studies. Even after restricting analyses to studies applying standardized diagnostic criteria (Fourth Report, ESH 2016, or AAP CPG), heterogeneity remained very high (I2 > 96%), and neither subgroup analyses nor meta-regression meaningfully explained this variability. This suggests that heterogeneity is likely driven by multiple interacting factors, including differences in study populations, measurement protocols, and unmeasured contextual variables.

In addition, a relative paucity of studies from the northern regions of Nigeria was observed, consistent with earlier findings [5]. This geographic imbalance may limit the generalizability of the results and suggests that unrepresented regional differences could have influenced the pooled estimates. This highlights the need for more geographically representative research, particularly in understudied regions of the country.

 

 

Conclusion Up    Down

The prevalence of hypertension among Nigerian children is substantial and may be increasing. Overweight and obesity were consistently associated with elevated blood pressure, highlighting the importance of early preventive strategies. A higher prevalence was observed among females; however, this finding should be interpreted cautiously given the observational nature of the included studies. There is a need for more robust, well-designed studies, particularly from underrepresented regions such as Northern Nigeria. In addition, the development and implementation of targeted prevention and screening programmes, aligned with the national NCD policy, are essential for the effective control of paediatric hypertension.

What is known about this topic

  • Control of elevated BP in childhood will prevent and reduce mortality from adult cardiovascular disease;
  • The prevalence of paediatric hypertension is significant and increasing worldwide;
  • The overweight/obesity epidemic significantly drives this increase.

What this study adds

  • This is the most up-to-date review on the subject in the country;
  • The review shows that the prevalence of hypertension is significant in Nigeria, a developing country;
  • It also shows a slight trend of higher prevalence in females, a finding that should, however, be interpreted cautiously.

 

 

Competing interests Up    Down

The authors declare no competing interests.

 

 

Authors' contributions Up    Down

Conception and study design: Kevin Bassey and Olumuyiwa Folayan; data collection and manuscript revision: Kevin Bassey, Ifunanya Ebiekpi, and Olumuyiwa Folayan; data analysis and interpretation and guarantor of the study: Kevin Bassey; manuscript drafting: Kevin Bassey and Ifunanya Ebiekpi. All the authors read and approved the final version of this manuscript.

 

 

Tables and figures Up    Down

Table 1: summary of studies on hypertension in Nigerian children included in the review and their main findings (N = 49)

Table 2: method of blood pressure measurement and guideline applied by included studies in the review (N = 49)

Table 3: sub-group analysis of study-level predictors of hypertension prevalence

Table 4: meta-regression analysis of study-level predictors of hypertension prevalence

Figure 1: PRISMA flow diagram outlining the search process for the review

Figure 2: pooled prevalence for childhood hypertension from included studies done in Nigeria 2000 - 2025: forest plot for studies included in meta-analysis (N = 38)

Figure 3: pooled prevalence of childhood pre-hypertension from included studies done in Nigeria 2000 - 2025: forest plot for studies included in meta-analysis (N = 24)

Figure 4: funnel plot for identification of publication bias in meta-analysis of studies for hypertension (N = 38)

Figure 5: gender risk ratio of childhood hypertension: forest plot from studies done in Nigeria 2000 - 2025 reporting on gender (N = 26)

 

 

Annex Up    Down

Annex 1: supplementary materials (PDF- 370KB)

 

 

References Up    Down

  1. World Health Organization. Noncommunicable diseases: key facts. 2025. Accessed 5th May, 2025.

  2. United Nations Department of Economic and Social Affairs. World population prospects: The 2017 revision. Key findings and advance tables. Working Paper No. ESA/P/WP/248. 2017.

  3. Hanson MA, Gluckman PD. Early developmental conditioning of later health and disease: physiology or pathophysiology? Physiol Rev. 2014 Oct;94(4):1027-76. PubMed | Google Scholar

  4. Brumana L, Arroyo A, Schwalbe NR, Lehtimaki S, Hipgrave DB. Maternal and child health services and an integrated, life-cycle approach to the prevention of non-communicable diseases. BMJ Glob Health. 2017 Aug 19;2(3):e000295. PubMed | Google Scholar

  5. Ejike CECC. Prevalence of Hypertension in Nigerian Children and Adolescents: A Systematic Review and Trend Analysis of Data from the Past Four Decades. J Trop Pediatr. 2017 Jun 1;63(3):229-241. PubMed | Google Scholar

  6. Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens. 1995 Jul;8(7):657-65. PubMed | Google Scholar

  7. Daniels M, Donilon T, Bollyky TJ. The emerging global health crisis: noncommunicable diseases in low- and middle-income countries. Council on Foreign Relations Independent Task Force Report. 2014 Dec 5(72). Google Scholar

  8. Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K et al. Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019 Dec 1;173(12):1154-1163. PubMed | Google Scholar

  9. Crouch SH, Soepnel LM, Kolkenbeck-Ruh A, Maposa I, Naidoo S, Davies J et al. Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis. EClinicalMedicine. 2021 Dec 6;43:101229. PubMed | Google Scholar

  10. Noubiap JJ, Essouma M, Bigna JJ, Jingi AM, Aminde LN, Nansseu JR. Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis. Lancet Public Health. 2017 Aug;2(8):e375-e386. PubMed | Google Scholar

  11. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev. 2022 Mar 27;18(2):e1230. PubMed | Google Scholar

  12. Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S et al. Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis. PLoS One. 2016 Jan 25;11(1):e0147601. PubMed | Google Scholar

  13. Owoeye OB, Olawale OA, Tella BA, Ajuluchukwu JN, Akinbo SR. Prevalence of hypertension and pre-hypertension in male adolescent football: A cross-sectional cohort study of Nigerian Players. Am J Hypertens Res. 2013;1:26-8. Google Scholar

  14. Ansa VO, Odigwe CO, Ekanem EE. Pattern of blood pressure in urban Nigerian adolescents-Experience from South-eastern Nigeria. Global Journal of Medical Sciences. 2002;1(1):1-6. Google Scholar

  15. Iduoriyekemwen NJ, Sadoh WE, Omuemu VO, Sadoh AE, Nwaneri UD, Adigweme IN et al. Blood pressure percentiles in Nigerian school-age children. Niger J Paediatr. 2014;41(3):223-8. Google Scholar

  16. Odunaiya NA, Grimmer K, Louw QA. High prevalence and clustering of modifiable CVD risk factors among rural adolescents in southwest Nigeria: implication for grass root prevention. BMC Public Health. 2015 Jul 14;15:661. PubMed | Google Scholar

  17. Afolabi BM, Holdbrooke SJ. Obesity, dyslipidemia and other risks factors for metabolic syndrome among indigenous black African secondary school students in Lagos, Nigeria. Qeios ID: S522VG. 2023 Oct 3;10:S522VG. Google Scholar

  18. Bugaje MA, Yakubu AM, Ogala WN. Prevalence of adolescent hypertension in Zaria. Nigerian Journal of Paediatrics. 2005;32(4):77-82. Google Scholar

  19. Mijinyawa MS, Iliyasu Z, Borodo MM. Prevalence of hypertension among teenage students in Kano, Nigeria. Niger J Med. 2008 Apr-Jun;17(2):173-8. PubMed | Google Scholar

  20. Odey F, Anah M, Ansa V, Ogbeche J, Meremikwu M, Ekanem E. Pre-Hypertension And Hypertension In Apparently Healthy Adolescents In Calabar, Nigeria. Global Journal of Community Medicine. 2009;2(1-2):13-20. Google Scholar

  21. Ansa VO, Anah MU, Odey FA, Mbu PN, Agbor EI. Relationship between parental socio-economic status and casual blood pressure in coastal Nigerian adolescents. West Afr J Med. 2010 May-Jun;29(3):146-52. PubMed | Google Scholar

  22. Ejike CE, Ugwu CE, Ezeanyika LU. Variations in the prevalence of point (pre)hypertension in a Nigerian school-going adolescent population living in a semi-urban and an urban area. BMC Pediatr. 2010 Mar 9;10:13. PubMed | Google Scholar

  23. Okoh BA, Alikor EA, Akani N. Prevalence of hypertension in primary school-children in Port Harcourt, Nigeria. Paediatr Int Child Health. 2012;32(4):208-12. PubMed | Google Scholar

  24. Ogboye O. Blood pressure and its correlates in children and adolescents in urban Nigeria. Warwick: University of Warwick. 2013. Google Scholar

  25. Ujunwa FA, Ikefuna AN, Nwokocha AR, Chinawa JM. Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria. Ital J Pediatr. 2013 Nov 2;39:70. PubMed | Google Scholar

  26. Omisore B, Omisore AG, Abioye-Kuteyi EA. Gender comparisons of adolescents' anthropometry and blood pressure in Osun State, South-Western Nigeria. Int J Adolesc Med Health. 2015 Aug;27(3):247-51. PubMed | Google Scholar

  27. Oyeyemi AY, Usman MA, Oyeyemi AL, Jaiyeola OA. Casual blood pressure of adolescents attending public secondary schools in Maiduguri, Nigeria. Clin Hypertens. 2015 Sep 3;21:16. PubMed | Google Scholar

  28. Ladapo TA, Fajolu IB, Adeniyi OF, Ekure EN, Maduako RO, Jaja TC et al. Blood pressure to height ratio as a screening tool for prehypertension and hypertension in adolescents. Niger J Clin Pract. 2016 May-Jun;19(3):401-6. PubMed | Google Scholar

  29. Sadoh WE, Sadoh AE, Onyiriuka AN. Physical activity, body mass index and blood pressure in primary school pupils attending private schools. Afr Health Sci. 2016 Dec;16(4):947-953. PubMed | Google Scholar

  30. Ajite AB, Aladekomo TA, Aderounmu T, Olowu WA. Burden of Hypertension and Abnormal Glomerular Permeability in Hypertensive School Children. Nephrourol Mon. 2016 May 21;8(4):e37568. PubMed | Google Scholar

  31. Uwaezuoke SN, Okoli CV, Ubesie AC, Ikefuna AN. Primary hypertension among a population of Nigerian secondary school adolescents: Prevalence and correlation with anthropometric indices: A cross-sectional study. Niger J Clin Pract. 2016 Sep-Oct;19(5):649-54. PubMed | Google Scholar

  32. Sadoh WE, Israel-Aina YT, Sadoh AE, Uduebor JE, Shaibu M, Ogonor E et al. Comparison of obesity, overweight and elevated blood pressure in children attending public and private primary schools in Benin City, Nigeria. Niger J Clin Pract. 2017 Jul;20(7):839-846. PubMed | Google Scholar

  33. Ezeudu CE, Chukwuka JO, Ebenebe JC, Igwe WC, Egbuonu I. Hypertension and prehypertension among adolescents attending secondary schools in urban area of South-East, Nigeria. The Pan African Medical Journal. 2018;31:145. PubMed | Google Scholar

  34. Ibrahim OR, Afolabi JK, Adedoyin OT, Ojuawo AI. Prevalence and risk factors for hypertension among school children in Ilorin, Northcentral Nigeria. J Family Community Med. 2019 Sep-Dec;26(3):181-186. PubMed | Google Scholar

  35. Ajayi IO, Oyewole OE, Onabanjo OO, Olawuwo MF, Salisu O. Blood pressure profile and nutritional status of pupils benefitting from the National Home-Grown School Feeding Programme in southwest Nigeria. Eur J Clin Exp Med. 2023;21(2):289-97. Google Scholar

  36. Ineju EO, Nsa EI, Amajor AC, Amah MU, Etuk IS, Nlemadim AC. Childhood Hypertension And Obesity In a Developing Country Setting: A Survey Among School Age Children In Calabar, Nigeria. Journal of Medicine in Africa. 2024 Oct 8;7(1):29-33. Google Scholar

  37. Hassan I, Sharif Hb, Ishaku S, Ahmed B, Shitu S. Prevalence of hypertension among primary school pupils in Sabon Gari Local Government Area Of Kaduna State. Journal of Health, Metabolism and Nutrition Studies. 2024. Google Scholar

  38. Otubo SA, Ujunwa FA, Manyike C, Nwokoye IC, Ezechukwu CC, Nnaemeka OK. Blood pressure profile and risk factors for hypertension among secondary school adolescents in Abakaliki, Southeast Nigeria. International Journal of Medicine and Health Development. 2025 Jul 1;30(3):244-53. Google Scholar

  39. Ani PN, Ezema CN, Okafor AM, Nnam NM. Hypertension and its association with anthropometric indices among Nigerian adolescents. Malawi Med J. 2025 Apr 2;37(1):36-43. PubMed | Google Scholar

  40. Ogunkunle OO, Odutola AO, Orimadegun AE. Pattern of blood pressure in apparently healthy Nigerian children aged 1-5 years. Niger J Paediatr. 2007;34(1-2):14-23. Google Scholar

  41. Ajaegbu O, Ezeonwu BU, Okike C, Muoneke UV, Okafor HU. Blood Pressure Profile of Apparently Healthy Primary School Children in Delta State, Nigeria: Impact of Social Factors and Anthropometric Variables. Open Journal of Pediatrics. 2020 Jul 7;10(3):576-85. Google Scholar

  42. Papka NY, Babaniyi IB, Aikhionbare HA, Oladele JT, Chinawa JM. Blood Pressure Pattern and Prevalence of Hypertension amongst Apparently Healthy Primary School Pupils in Abuja, Nigeria. Niger Postgrad Med J. 2024 Apr 1;31(2):111-117. PubMed | Google Scholar

  43. Okpokowuruk FS, Akpan MU, Ikpeme EE. Prevalence of hypertension and prehypertension among children and adolescents in a semi-urban area of Uyo Metropolis, Nigeria. The Pan African Medical Journal. 2017 Dec 8;28:303. PubMed | Google Scholar

  44. Asani MO, Bode-Thomas F. Blood pressure pattern and its correlates among primary school children in Jos, Nigeria. Highland Med Res J. 2005;3(2):51-61. Google Scholar

  45. Senbanjo IO, Oshikoya KA. Obesity and blood pressure levels of adolescents in Abeokuta, Nigeria. Cardiovasc J Afr. 2012 Jun;23(5):260-4. PubMed | Google Scholar

  46. Akor F, Okolo SN, Okolo AA. Blood pressure and anthropometric measurements in healthy primary school entrants in Jos, Nigeria. South African Journal of Child Health. 2010 Jun 1;4(2):42-5. Google Scholar

  47. Okagua J, Anochie IC, Akani NA. Adolescent blood pressure pattern in Rivers State, Nigeria: A rural-urban comparison. Nigerian Journal of Paediatrics. 2015;42(1):21-7. Google Scholar

  48. Akintayo-Usman NO, Okanlawon FA, Usman SO. Prevalence of pre-diabetes and risk factors among secondary school adolescents in Osogbo Local Government Area, Osun State, Nigeria. Afr Health Sci. 2021 Sep;21(3):1301-1309. PubMed | Google Scholar

  49. Umuerri EM, Oyibo P, Oyibo IA, Eyawo O. Prevalence of High Blood Pressure and Associated Factors among a Population of Apparently Healthy in-School Adolescents in Delta State, Nigeria: A Cross-Sectional Survey. West Afr J Med. 2024 Jun 28;41(6):691-698. PubMed | Google Scholar

  50. Musa DI, Toriola AL, Goon DT, Jonathan SU. Association of Fitness and Fatness with Clustered Cardiovascular Disease Risk Factors in Nigerian Adolescents. Int J Environ Res Public Health. 2020 Aug 13;17(16):5861. PubMed | Google Scholar

  51. Alabi KO, Kayode-Alabi TF, Ibrahim RO, Issa H, Abdulkadir MB, Ernest SK et al. Relationship Between Microalbuminuria and Risk Factors for Cardiovascular Diseases Among Secondary School Student in Ilorin, Nigeria. Journal of Nepal Paediatric Society. 2021 Dec 31;41(3):425-31. Google Scholar

  52. Oduwole AA, Ladapo TA, Fajolu IB, Ekure EN, Adeniyi OF. Obesity and elevated blood pressure among adolescents in Lagos, Nigeria: a cross-sectional study. BMC Public Health. 2012 Aug 7;12:616. PubMed | Google Scholar

  53. Oyewole OO, Oritogun KS. Pre-hypertension and hypertension in adolescence: how much does it occur in a Nigerian community? West Afr J Med. 2012 Apr-Jun;31(2):71-5. PubMed | Google Scholar

  54. Odetunde OI, Neboh EE, Chinawa JM, Okafor HU, Odetunde OA, Ezenwosu OU et al. Elevated arterial blood pressure and body mass index among Nigerian preschool children population. BMC Pediatr. 2014 Mar 4;14:64. PubMed | Google Scholar

  55. Chuemere AN, Olorunfemi OJ, Nwogu JU, Mmom OF, Agbai EO, Vurey VV. Correlation between blood group, hypertension, obesity, diabetes, and combination of prehypertension and pre-diabetes in school aged children and adolescents in Port Harcourt. IOSR Journal of Dental and Medical Sciences. 2015 Dec;14(12):83-9. Google Scholar

  56. Jaja T, Yarhere IE. Risk factors for type 2 diabetes mellitus in adolescents secondary school students in Port Harcourt, Nigeria. Niger J Paediatr. 2015;42(2):137-41.

  57. Adam VY, Isah JA. Prevalence and comorbidities of childhood overweight and obesity among school aged children in an urban settlement in Benin City, Nigeria. Niger J Paediatr. 2017;44(1):7-13.

  58. Aliu R, Peter TY, Uniga JA, Ishaku H, Bello AA, Abdulgafar LO, Briggs DC. Sociodemographic Correlates of Hypertension in Apparently Healthy Secondary School Adolescents in Taraba State, Nigeria. Nigerian Journal of Paediatrics. 2025 Jul 17;52(2):142-51. Google Scholar

  59. Musa AZ, Umar UI, Obiagwu PN, Ibrahim M. School-based Study of the Prevalence and Associated Factors of Prediabetes Among Adolescents in Kano, Nigeria. Niger Med J. 2023 May 5;64(1):43-53. PubMed | Google Scholar

  60. Enuagwuna FC, Asiboje ET, Ofurum IC, Wilcox SA. Risk and Determinants of Non-communicable Diseases Among Adolescents in Public and Private Secondary Schools in Port Harcourt, Rivers State, Nigeria. World Journal of Public Health. 2024 Nov;9(4):366-79. Google Scholar

  61. Okpebholo EG, Oludahunsi OF, Ijarotimi OS. Early Onset of Hypertension and Diabetes: Prevalence and Risk Factors among School Going Adolescents in Federal Capital Territory, North Central Nigeria. International Journal of Research. 2025 Feb;10:279-91. Google Scholar

  62. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-76. PubMed | Google Scholar

  63. Flynn JT, Falkner BE. New Clinical Practice Guideline for the Management of High Blood Pressure in Children and Adolescents. Hypertension. 2017 Oct;70(4):683-686. PubMed | Google Scholar

  64. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics. 1996 Oct;98(4 Pt 1):649-58. PubMed | Google Scholar

  65. Fuchs FD, Whelton PK. High Blood Pressure and Cardiovascular Disease. Hypertension. 2020 Feb;75(2):285-292. PubMed | Google Scholar

  66. Lee MR, Lim YH, Hong YC. Causal association of body mass index with hypertension using a Mendelian randomization design. Medicine (Baltimore). 2018 Jul;97(30):e11252. PubMed | Google Scholar

  67. Kelley GA, Kelley KS, Pate RR. Exercise and BMI in Overweight and Obese Children and Adolescents: A Systematic Review and Trial Sequential Meta-Analysis. Biomed Res Int. 2015;2015:704539. PubMed | Google Scholar

  68. Sobol-Goldberg S, Rabinowitz J, Gross R. School-based obesity prevention programs: A meta-analysis of randomized controlled trials. Obesity (Silver Spring). 2013 Dec;21(12):2422-8. PubMed | Google Scholar

  69. Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015 Jul;16(7):547-65. PubMed | Google Scholar

  70. Federal Ministry of Health, Abuja, Nigeria. National policy and strategic plan of action on prevention and control of noncommunicable diseases. 2013. Accessed 29th October, 2025.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Search

Volume 54 (May - Aug 2026)

This article authors

On Pubmed
On Google Scholar

Citation [Download]

Zotero
EndNote XML
Reference Manager
BibTex
ProCite

Navigate this article

Similar articles in

Key words

Tables and figures

Table 1: summary of studies on hypertension in Nigerian children included in the review and their main findings (N = 49)
Table 2: method of blood pressure measurement and guideline applied by included studies in the review (N = 49)
Table 3: sub-group analysis of study-level predictors of hypertension prevalence
Table 4: meta-regression analysis of study-level predictors of hypertension prevalence
Figure 1: PRISMA flow diagram outlining the search process for the review
Figure 2: pooled prevalence for childhood hypertension from included studies done in Nigeria 2000 - 2025: forest plot for studies included in meta-analysis (N = 38)
Figure 3: pooled prevalence of childhood pre-hypertension from included studies done in Nigeria 2000 - 2025: forest plot for studies included in meta-analysis (N = 24)
Figure 4: funnel plot for identification of publication bias in meta-analysis of studies for hypertension (N = 38)
Figure 5: gender risk ratio of childhood hypertension: forest plot from studies done in Nigeria 2000 - 2025 reporting on gender (N = 26)

Article metrics

Countries of access

PlumX Metrics

Paediatric hypertension in Nigeria (2000 - 2025): a systematic review and meta-analysis

Recently from the PAMJ

Addressing barriers to healthcare access for migrant workers in Indonesia: a legal and policy analysis of sexual and reproductive health rights

Incidental detection of sickle cell trait during routine HbA1c monitoring by HPLC: analytical and clinical implications in a Moroccan population

Pleural biphasic synovial sarcoma: a case report

Histological subtype and tumour differentiation as predictors of survival among patients with non-small cell lung cancer in specialised hospitals in Ethiopia

Association between anthropometric indices and electrocardiographic variables among healthy black adolescents

Authors´ services