Factors Associated With Hypertension in Ethiopia: A Systematic Review, Meta-Analysis, and Quantitative Framework for Comparative Association

Hypertension is a leading cause of cardiovascular morbidity and mortality worldwide and represents a growing public health challenge in Ethiopia. Multiple demographic, metabolic, behavioral, and socioeconomic factors contribute to its development; however, the relative importance of these factors remains unclear.

To synthesize evidence on factors associated with hypertension in Ethiopia and compare the strength and consistency of these associations.

A systematic review was conducted following the PRISMA guidelines, with searches of PubMed/MEDLINE, Scopus, EMBASE, Web of Science, the Cumulative Index for Nursing and Allied Health Literature (CINAHL), and African Journals Online (SABINET) from inception to March 2026. Observational studies reporting factors associated with hypertension in adults in Ethiopia were included. We performed a random-effects meta-analysis for factors with sufficient homogeneity, whereas other variables were synthesized narratively. A quantitative framework based on risk weight estimates was used to compare the strength and consistency of the associations and explore risk clustering; the findings were interpreted as indicative rather than causal.

Forty-one studies, predominantly cross-sectional. Older age was strongly associated with hypertension (pooled OR 2.90, 95% CI: 2.07-4.07). Obesity and being overweight were consistently associated with increased odds (pooled OR ≈ 2.0-3.5). Diabetes showed a markedly elevated association (pooled OR = 11.47, 95% CI: 1.11-118.23), with wide confidence intervals. Behavioral factors, including alcohol use and physical inactivity, showed moderate but inconsistent associations, whereas socioeconomic factors were context-dependent. Risk weight estimates indicated that diabetes (Rw = 2.5) and older age (Rw = 1.8) had the most consistent association with the outcome.

In Ethiopia, hypertension is strongly associated with metabolic factors, particularly age and diabetes, as well as with variable behavioral and socioeconomic influences. These findings support integrated prevention strategies that target high-risk groups, defined here as groups with comparatively stronger observed associations with hypertension rather than prospectively established risk.