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We did the first systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa.We did a comprehensive literature search to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic.We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54196 participants aged 2–19 years. Prevalence of elevated blood pressure varied widely across studies (range 0.2–24.8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5.5% (95% CI 4.2–6.9) (Figure 1), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and < 95th percentile) was 12.7% (2.1–30.4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30.8%, 95% CI 20.1–42.6) versus normal-weight children (5.5%, 3.1–8.4; p < 0.0001).This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity.