Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review

Hypertension. 2022 May;79(5):898-905. doi: 10.1161/HYPERTENSIONAHA.121.17949. Epub 2022 Mar 11.


Background: Sub-Saharan Africa (SSA) has the highest age-adjusted burden of hypertension and cardiovascular disease (CVD). SSA also experiences many viral infections due to unique environmental and societal factors. The purpose of this narrative review is to examine evidence around how hypertension, CVD, and emerging viral infections interact in SSA.

Methods: In September 2021, we conducted a search in MEDLINE, Embase, and Scopus, limited to English language studies published since 1990, and found a total of 1169 articles. Forty-seven original studies were included, with 32 on COVID-19 and 15 on other emerging viruses.

Results: Seven articles, including those with the largest sample size and most robust study design, found an association between preexisting hypertension or CVD and COVID-19 severity or death. Ten smaller studies found no association, and 17 did not calculate statistics to compare groups. Two studies assessed the impact of COVID-19 on incident CVD, with one finding an increase in stroke admissions. For other emerging viruses, 3 studies did not find an association between preexisting hypertension or CVD on West Nile and Lassa fever mortality. Twelve studies examined other emerging viral infections and incident CVD, with 4 finding no association and 8 not calculating statistics.

Conclusions: Growing evidence from COVID-19 suggests viruses, hypertension, and CVD interact on multiple levels in SSA, but research gaps remain especially for other emerging viral infections. SSA can and must play a leading role in the study and control of emerging viral infections, with expansion of research and public health infrastructure to address these interactions.

Keywords: Africa South of the Sahara; cardiovascular diseases; hypertension; public health; virus diseases.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Africa South of the Sahara / epidemiology
  • COVID-19* / epidemiology
  • Cardiovascular Diseases* / epidemiology
  • Humans
  • Hypertension* / epidemiology
  • Risk Factors