Frontiers in Cardiovascular Medicine · Nov 2, 2026
Factors Associated with Hypertension in Nigeria: A Systematic Review and Meta-analysis with an Exploratory Risk Stratification Framework
By Martins Nweke, Julian Pillay
Background: Hypertension is a growing public health problem in Nigeria, associated with several demographic, metabolic, behavioural, and socioeconomic factors. Because these associations vary in magnitude and direction, prevention priorities remain unclear. Aim: To identify and quantify the factors associated with hypertension in Nigeria. Methods: Following the PRISMA 2020 statement, we searched PubMed, MEDLINE, CINAHL Complete, and Academic Search Complete from inception to January 2026. Two reviewers independently screened records and full texts. Study-level odds ratios (ORs) were brought to common comparisons, recalculated as crude ORs from reported counts where possible, and pooled using random-effects models (REML with Hartung–Knapp–Sidik–Jonkman confidence intervals) with 95% prediction intervals (PIs). Heterogeneity was explored with subgroup analyses and meta-regression. GRADE certainty started at low for observational evidence. An exploratory prioritisation framework is reported as a hypothesis-generating supplement. Results: Twenty-two studies (47,262 participants; 21 cross-sectional, 1 case–control) were included, and 21 factors were pooled. Hypertension was associated with age ≥50 years (4.39, 3.14–6.14), central obesity (3.06, 1.94–4.82), obesity (3.00, 1.63–5.49), overweight (1.97, 1.44– 2.69), dyslipidaemia (3.59, 1.49–8.63), family history (1.97, 1.31–2.97), being currently married (3.03, 2.01–4.55) or once married (5.18, 2.80–9.58), no formal education (1.78, 1.04–3.07), smoking/tobacco use (1.70, 1.12–2.57), high salt intake (2.44, 1.02–5.85), and physical inactivity (1.32, 1.11–1.58). After age adjustment, the marital-status associations fell to 1.77 and 1.78, respectively. The diabetes result was inconclusive (3.15, 0.95–10.45; I² = 87%) and rested mainly on 72 participants with self-reported diabetes in one study. Heterogeneity was substantial for most factors; setting explained part of it for marital status, family history, and smoking. Certainty was low for age ≥50 years and central obesity, the only factors whose PIs excluded 1, and very low for all other factors. Conclusion: In Nigeria, older age and central obesity are consistently associated with hypertension, with low certainty. Associations with other adiposity measures, dyslipidaemia, family history, marital status, education, smoking, salt intake, and physical inactivity are of very low certainty and vary across settings. The association with diabetes was inconclusive. Prospective studies with standardised measurements are required.