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While traditionally viewed as a regional practice with limited relevance to Western societies, modern distribution networks and diaspora communities have facilitated its international spread, transforming khat into a global substance of concern. This study builds upon existing evidence by synthesizing data from fifteen studies which is significantly more than previous reviews to firmly establish khat (\n                      <jats:italic>Catha edulis<\/jats:italic>\n                      ) use as a risk factor for elevated blood pressure and tachycardia, both of which are key precursors to hypertension.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This systematic review and meta-analysis aimed to aimed to systematically evaluate, and synthesize the available evidence on the epidemiological association between khat (\n                      <jats:italic>Catha edulis<\/jats:italic>\n                      ) chewing as an exposure and hypertension as an outcome, 2024.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The comprehensive search of this systematic review and meta-analysis included cross-sectional and case-control studies published in English from inception up to December 30, 2024 on association between khat (\n                      <jats:italic>Catha edulis<\/jats:italic>\n                      ) and hypertension. Excluded were conference proceedings, qualitative research, commentaries, editorial letters, case reports, case series, and monthly and annual police reports. The search covered full-text publications written in English and databases such as PubMed\/MEDLINE, African Journals Online (AJOL), and Google Scholar. A checklist from the Joanna Briggs Institute (JBI) was used to evaluate the quality of the studies. Two independent reviewers performed data extraction, critical appraisal, and article screening. Assessment of the certainty evidences was done by applying the GRADE method. The statistical analysis was done using the software packages STATA-17 and RevMan 5.4. The Cochrane Q statistic with I\n                      <jats:sup>2<\/jats:sup>\n                      was used to assess between study heterogeneity. A weighted inverse variance random effects model was used to calculate the pooled odds ratio with 95% confidence interval.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen studies were included in this systematic review and meta-analysis. From meta-analysis, a total of 12,409 participants were involved. Of the 3986 Khat chewers, 1278 were found to have hypertension. On contrary, out of the 8423 of non-chewers, 1341 were found to have hypertension. Pooled analysis showed that khat chewer were 2.4 times more likely to have hypertension as compared to non-khat chewer (OR 2.4, 95%CI 1.48\u20133.88) at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004, I\n                      <jats:sup>\n                        <jats:bold>2<\/jats:bold>\n                      <\/jats:sup>\n                      \u2009=\u200993% (95% CI: 88\u201396%). The findings of the Egger\u2019s test (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009= 0.655) and funnel plot revealed that no evidence of publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This systematic review suggests khat chewing as a significant modifiable risk factor for hypertension, urging targeted public health interventions, policy regulation, and integration of cessation counseling into healthcare programs. Future research should employ rigorous designs, standardized measurements, and broader literature inclusion to strengthen causal evidence, while collaboration with endemic regions and objective biomarker use could enhance data reliability and generalizability. Addressing khat use may substantially reduce hypertension-related cardiovascular burdens in affected populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      This systematic review and meta-analysis was registered in PROSPERO with the registration ID and link as follows: CRD42024555322: Available from:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php\" ext-link-type=\"uri\">https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-025-05160-2","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:52:46Z","timestamp":1761047566000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Does regular Khat (Catha edulis) chewing in adults increase the risk of hypertension compared to non-use? 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