The Epidemiology of Pulmonary Hypertension in Sub-Saharan Africa-A Systematic Report

Noncommunicable diseases (NCDs) are on the rise in sub-Saharan Africa (SSA), with cardiovascular NCD accounting for most deaths. Pulmonary hypertension (PH) is a highly morbid NCD; however, contemporary prevalence data are lacking. We performed a systematic literature search of all echocardiographic or right heart catheterization studies performed in SSA. We grouped studies based on disease populations and performed random-effects meta-analyses, meta-regression, and extrapolation analyses. We included n = 105 reports, comprising 23,384 individuals. Most investigated cohorts included sickle cell disease (SCD; n = 24), human immunodeficiency virus (HIV; n = 19), rheumatic heart disease (RHD; n = 18), hypertensive heart failure (HHF; n = 7), and other heart failure (HF) syndromes (n = 18), while others, including chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis (TB), chronic kidney disease (CKD) and schistosomiasis were underreported and prevalence of PH in patients with specific PH-predisposing diseases from other global regions was used. Estimated PH prevalence was strongly dependent on tricuspid regurgitation velocity (TRV) threshold, referral reason for echocardiography (HIV), and disease severity (RHD, HHF, HF). When taking these factors into account, extrapolation suggests that up to 1.2% may had "likely" PH TRV > 3.4 m/s) and 1.9% "at risk" PH (TRV > 2.8 m/s) in SSA in 2021, with the largest contributor being RHD (31%), followed by other HF (25%), COPD (18%), CKD (14%), HIV (5%), SCD (4%), schistosomiasis (2%), and TB (1%). PH has a unique epidemiological profile in SSA and based on our extrapolation methods PH prevalence is substantial but varies by disease population, disease severity, and specificity of diagnostic criteria. Population health initiatives focusing on PH prevention, detection, and management in SSA are warranted. Trial Registration: PROSPERO: CRD42023478199.