Less than 100 years ago reports from studies in Kenya indicated that the prevalence of hypertension was exceptionally low in tribal areas that have undergone no changes possibly for centuries. In recent decades, however, the transition of populations in many African countries from traditional lifestyles to urbanised environments seems to have contributed to the significant escalation of hypertension and cardiovascular events in black populations. This is confirmed by reports from the World Health Organization indicating that the prevalence of hypertension is globally the highest on the African continent. Research done during the past decade in South Africa has shown that environmental factors, such as accessibility to sugary drinks, have contributed to the obesity epidemic. Furthermore, in a 5-year follow-up study we have indicated that central obesity and excessive alcohol use have played a major role in the occurrence of incident hypertension. In Sub-Saharan Africa that is burdened by both a high prevalence of infectious diseases and non-communicable diseases urgent concerted efforts and research capacity are required to curb the wave of hypertension and its consequences.