Link Between Obesity and Hypertension in East African Women: A Narrative Review

East African women are at the epicenter of a fast-moving cardiometabolic transition in which rising overweight/obesity increasingly coexists with a substantial, under-recognized burden of hypertension. This review synthesizes evidence supporting a plausible causal pathway: excess adiposity promotes sympathetic overactivity, RAAS upregulation, insulin resistance, endothelial dysfunction, renal sodium retention, and chronic low-grade inflammation mechanisms that converge to raise and sustain blood pressure. These biological risks are amplified by women’s life-course exposures, including pregnancy-related weight retention and midlife shifts toward central adiposity, and by gendered constraints such as time poverty, unsafe or limited spaces for physical activity, and food environments dominated by inexpensive, energy-dense options. Cultural norms that normalize larger body size may further delay risk recognition and timely screening. We argue for an integrated, women-centered response: routine BP and adiposity screening at high-coverage touchpoints (ANC/PNC, family planning, immunization clinics), community outreach, and culturally adapted lifestyle programs emphasizing practical dietary swaps, salt reduction, and accessible physical activity. Strengthened primary-care hypertension management, task-shifting, reliable medicines, and adherence support are essential to reduce preventable CVD and intergenerational risk. Keywords: East Africa; women; overweight/obesity; hypertension; cardiometabolic transition; RAAS; sympathetic activation; salt reduction; primary care; ANC/PNC.