The cascade of hypertension prevalence, awareness, treatment, and control in urban-poor communities in Accra, Ghana: a population-based household survey

Background: Hypertension is the leading modifiable risk factor for morbidity and mortality from cardiovascular diseases and poses a significant health challenge in low- and middle-income settings, including in sub-Saharan Africa. We set out to: (1) examine the prevalence, awareness, treatment and control of hypertension, and their associated factors, and (2) determine the prevalence of pre-hypertension and its associated factors in an urban poor setting in Ghana. Methods: This population-based household survey was conducted among a random sample of 854 participants aged ≥ 25 years in Ga Mashie, Accra. Blood pressure was measured using standard protocol. Data were analyzed using multivariable binary logistic regression. Results were presented as adjusted odds ratios (AOR) and their associated 95% confidence intervals (CI). Results: Of the 854 participants (64.1% women; median age [IQR], 46.0 [14.0] years), 47.3% (95% CI: 44.0%-50.7%) had hypertension, of whom 45.5% (95% CI: 40.7–50.4) were aware, 36.1% (95% CI: 31.6–41.0) received treatment in the last 12 months, 30.0% (95% CI: 25.7–34.6) were on treatment in the last 14 days and 16.1% (95% CI: 12.8–20.0) achieved adequate blood pressure control. Being overweight/obese (AOR = 1.41, 95% CI = 1.01–1.96) and having a family history of diabetes (AOR = 2.03, 95% CI = 1.24–3.33) were associated with hypertension prevalence. Those with diabetes (AOR = 2.95, 95% CI = 1.18–7.38) and current alcohol consumers (AOR = 2.63, 95% CI = 1.15–7.38) were more likely to have controlled hypertension compared to their counterparts. Pre-hypertension prevalence was 27.8%, and the determinants include being male, being employed and having a high household size. Conclusions: Although high rates of hypertension and prehypertension were reported in this study, awareness, treatment, and control rates were relatively low. These findings suggest that adults in Ga Mashie run a high risk of hypertension complications such as cardiovascular diseases and stroke, and this calls for urgent interventions to reduce blood pressure levels and exposure to hypertension risks in the community.