Background There is minimal data on the number of adolescents in sub-Saharan Africa (SSA) with elevated blood pressure (BP) at increased risk of future cardiovascular events. Combining country-specific population data with data derived from two previously conducted meta-analyses (one African-specific, one based on international cohorts), we sought to address this knowledge deficit.

Methods We used meta-analysis data from 37 926 adolescents participating in 36 contemporary SSA studies to generate sex-specific proportions of adolescents aged 10–14 and 15–19 years with elevated BP. The estimates were applied to the 2021 World Bank population data for each country in SSA. We then applied the rate of cardiovascular events attributable to elevated BP levels, derived from a meta-analysis of 17 observational, longitudinal cohort studies comprising 4.5 million young adults (non-African), to determine the excess number of cardiovascular events linked to hypertension among those aged 15–19 years transitioning to adulthood.

Results The estimated prevalence of elevated BP among male and female adolescents aged 10–14 years living in SSA was 7.2% (95% confidence interval (CI) = 4.9–9.9) and 6.9% (95% CI = 4.7–9.5), respectively, which increased to 13.0% (95% CI = 10.6–15.6) and 12.5% (95% CI = 10.4–15.3) among male and female adolescents aged 15–19 years, respectively. Consequently, we estimate that 13.6/138.0 million (95% CI = 10.4–17.3) male and 12.9/135.7 million (95% CI = 9.83–16.3) female adolescents living in SSA have elevated BP. Among the estimated 16.1 million adolescents aged 15–19 years with elevated BP approaching adulthood, the projected excess in cardiovascular events attributable to hypertension (vs normotension) is 201 000 (95% CI = 115 000–322 000) to 503 000 (95% CI = 286 000–805 000) over the next 10–25 years.

Conclusions Based on the best available data, we estimate that 26.5 million adolescents living in SSA have elevated BP. If left undetected and untreated among those approaching adulthood (those aged 15–19 years), they will experience >0.5 million excess cardiovascular events associated with persistently elevated BP within the next 25 years.

Registration PROSPERO: CRD42022297948.