Beyond prevalence: a systematic review and meta-analysis of risk factors and management interventions for hypertension in Ghana

Introduction Hypertension (HTN) is an essential public health issue globally and an important preventable predisposing factor for cardiovascular complications. This project seeks to examine risk factors and current protocols used in the management and control of HTN in the Ghanaian healthcare setting. Methods A systematic review was conducted in accordance with PRISMA reporting guidance. PubMed, Web of Science, EMBASE and the Cochrane Library were searched, supplemented by grey-literature and institutional-repository searches. The principal search covered studies published from 2017 to May 2025, with one earlier nationally representative WHO SAGE study retained for risk-factor characterisation. Of 2,980 records initially identified, 24 studies met the eligibility criteria. Joanna Briggs Institute critical appraisal tools were applied according to study design. Random-effects meta-analysis was undertaken only for sufficiently comparable outcomes; heterogeneous risk-factor, intervention, qualitative and health-system evidence was synthesised narratively. Findings Hypertension prevalence increased markedly with age, with consistently higher prevalence observed among older adults. The random-effects meta-analysis of sufficiently comparable population-based studies yielded a pooled hypertension prevalence of 27.6% (95% CI 26.6–28.6%), with substantial between-study heterogeneity (I² = 78.4%). Across the included studies, obesity, diabetes mellitus and family history were consistently associated with higher hypertension prevalence; however, the available evidence was predominantly cross-sectional and did not support pooled causal risk estimates. Regional and urban–rural disparities were also evident. Intervention studies suggested potentially beneficial effects of nurse-led task-strengthening and community-based hypertension programmes on awareness, treatment and blood-pressure control, but heterogeneity in study designs, outcome definitions and follow-up precluded formal comparative pooling of intervention effectiveness. Conclusion Hypertension remains an important public health challenge in Ghana, with substantial variation by age, cardiometabolic risk profile and geographical setting. Available evidence suggests that strengthening integrated primary healthcare, nurse-led task-sharing and community-based hypertension services may contribute to improved prevention and control. However, the limited number of randomised and prospective studies means that conclusions regarding comparative intervention effectiveness should be interpreted cautiously. Recommendations There should be a deliberate implementation of countrywide task-shifting HTN management programmes, expanding the scope of community-based interventions by integrating HTN management into existing Community-based Health Planning Services infrastructure, establishing nurse-led HTN clinics, and broadening the scope of population screening campaigns.