Prevalence and associated factors of hypertension among Africans

Hypertension is a leading global public health problem and the foremost risk factor for premature death and cardiovascular disease. Sub-Saharan Africa is undergoing a rapid epidemiological transition, with roughly one in three adults now hypertensive; in Ghana, age-standardised prevalence reached 34% in 2023. Despite effective treatments being available, major gaps persist in detection, treatment, and control, particularly where structural inequities and financial barriers disrupt the care cascade.
This thesis examines the prevalence, determinants, and management of hypertension among Africans, with a focus on Ghana, and evaluates the potential of digital health and psychosocial support to close these gaps. Using quantitative surveys, qualitative interviews, and a systematic review and meta-analysis, the work is organised around three themes: the population burden of and barriers to hypertension management, clinical and psychosocial determinants among high-risk groups, and the potential of digital and psychosocial interventions.
Findings show a high hypertension prevalence (26.0%) in urban coastal communities, with female sex, older age, alcohol use, and lower household income as key predictors, alongside financial and systemic barriers to care that drive reliance on herbal remedies. Among patients with type 2 diabetes, hypertension co-occurred in 79.9% of cases, and quality of life was closely tied to employment and insurance status. A systematic review found that digital health interventions, particularly simple SMS-based messaging, significantly reduce blood pressure and improve medication adherence in low-resource settings, outperforming more complex smartphone applications. Coping and resilience, especially collective/community-based coping, were associated with better blood pressure control.
Together, these findings offer an evidence base for designing more equitable, context-appropriate strategies to detect, treat, and control hypertension across African settings.