Five-year trends in hypertension surveillance in the Hohoe Municipality, Volta Region, Ghana (2020 –2024): Burden, gaps, and public health implications

Introduction Hypertension is a leading modifiable risk factor for cardiovascular disease, stroke and chronic kidney disease, and its burden is growing in sub-Saharan Africa. In Ghana, surveillance data are rarely analysed locally to guide public health action. We analysed 2020–2024 hypertension surveillance data from the Hohoe Municipality, Volta Region, to describe trends, identify high-risk populations and assess surveillance system performance. Methods We conducted a descriptive cross-sectional surveillance evaluation using data retrieved from the District Health Information Management System 2 (DHIMS2) for 2020–2024. Data were analysed in Microsoft Excel and mapped using ArcMap. Guided by the updated guidelines for evaluating public health surveillance systems, findings were disaggregated by person, place and time. Results A total of 16,492 new hypertension cases were recorded. Annual cases rose from 1,684 in 2023 to 2,878 in 2024, a 70.9% increase driven by expanded facility reporting (5 active facilities in 2020 to 14 in 2024). Adults aged 50 years and older accounted for 68.3% of cases. Hohoe Urban sub-district contributed 89.5% of cases, whereas Agumatsa/Wli recorded only 22 cases over the period, indicating a critical detection gap. Facility participation improved from 25% (5/20) in 2020 to 70% (14/20) in 2024. Estimated annual detection was 6–7% of the projected disease burden, an iceberg ratio of 13–14 undetected cases for every case detected. Conclusion The burden of hypertension in the Hohoe Municipality is increasing and grossly under-detected. Community-based screening should be scaled up urgently in under-screened sub-districts, DHIMS2 data completeness strengthened, and surveillance outputs used explicitly for health planning to change Ghana’s hypertension trajectory.