Stroke and high blood pressure are major causes of death and disability worldwide. Although comprehensive stroke surveillance data for Africa are lacking, the available data show that age-standardised mortality, case fatality and prevalence of disabling stroke in Africa are similar to or higher than those measures in most high-income regions. In Africa, more than 90% of patients with haemorrhagic stroke and more than half with ischaemic stroke are found to have high blood pressure. However, awareness of hypertension and its prevention, treatment and control remain very low in Africa even though recent surveys show an increasing prevalence of the disease consistent with the nutritional and epidemiological transition in the region. Renewed emphasis on improved surveillance and the prevention and control of high blood pressure and stroke in Africa is needed.