Abstract Body: Background
Noncommunicable diseases are rising across Africa, yet regional profiles of key cardiometabolic risk factors remain incompletely characterized. We compared age-standardized prevalence of hypertension, diabetes, overweight, and obesity across African subregions using comparable WHO STEPS data.

Methods
We analyzed nationally representative WHO STEPS surveys of adults 18–69 years from 18 countries (survey years varied by country). Country-specific, age-standardized prevalences (direct standardization to the WHO World Standard Population) were pooled overall and by subregion (North, West, East, Central, Southern Africa) using random-effects meta-analysis. We summarized the prevalence estimates by sex and age and between-study heterogeneity was examined using I². Outcomes used standard thresholds: hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg or treatment), diabetes (fasting glucose ≥7.0 mmol/L or prior diagnosis), overweight (BMI ≥25), and obesity (BMI ≥30).

Results
Across 79,297 participants (mean, SD 36.3 ± 12.9 years) from 18 African countries, pooled prevalence was 6.2% for diabetes, 27.8% for hypertension, 14.5% for obesity, and 36.3% for overweight, with modest between-survey heterogeneity (I²=1%). Clear regional patterns emerged across the continent. North Africa exhibited the highest burden of metabolic conditions, with diabetes affecting 9.6% of participants, obesity 23%, and overweight 57%. Southern Africa had the highest hypertension prevalence at 35%, closely followed by West Africa at 32%. In contrast, East and Central Africa showed consistently lower rates across all measures: East Africa had just 6% obesity and 22% overweight, while Central Africa had 49% overweight. Hypertension showed marked age-related increases, reaching approximately 55-57% among those aged 60-69 years. Sex differences in overall hypertension prevalence were minimal (males 26.4% vs females 26.8%). Notably, despite substantial variation in hypertension prevalence across regions, mean systolic blood pressure remained relatively consistent, ranging from 123-127 mmHg.

Conclusions
The burden of cardiometabolic risk factors in Africa is high and heterogeneous, with adiposity concentrated in the north and hypertension highest in the south and west. Findings support targeted obesity prevention in high-adiposity regions and scale-up of hypertension case-finding and treatment, particularly among older adults.