Currently submitted to: JMIR Formative Research
Date Submitted: Sep 26, 2026
Open Peer Review Period: Sep 27, 2026 - Nov 22, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Impact of the Ghana Heart Initiative Capacity-Building Program on Hypertension Control: Evaluation in the Greater Accra Region, Ghana
ABSTRACT
Background:
Hypertension remains a major public health challenge across Africa because of low control rates. In a global Lancet Non-Communicable Disease (NCD) Risk study, the national BP control in Ghana remains below 20%, underscoring critical gaps in detection, treatment, and long term management. To address these deficiencies, the Ghana Heart Initiative (GHI) implemented a comprehensive capacity-building programme aimed at strengthening hypertension and cardiovascular diseases management within primary, secondary and tertiary
Objective:
To evaluate the impact of the Ghana Heart Initiative capacity-building programme on BP levels and hypertension control among adults in the Greater Accra Region.
Methods:
We conducted a quasi-experimental study in Greater Accra between September 2020 and December 2023 involving 1,849 adults newly diagnosed with hypertension. BP was assessed at baseline, and at 3, 6, and 12 months. We compared the national BP control rate of 18.6% to the control after GHI intervention. The intervention comprised a multifaceted capacity building programme that included cardiovascular disease-focused clinical training, provision of equipment, mentorship program, digital health application, and call-centre support for clinicians. BP control was assessed using thresholds from JNC8, WHO, ESH and ACC/AHA criteria. Analyses included paired comparisons, McNemar tests, and difference-in-differences models.
Results:
Mean baseline systolic and diastolic BP were 162.1 and 94.6 mmHg, respectively, with no significant sex differences. By 12 months, systolic BP had declined by 16.6 and diastolic BP by 7.7 mmHg and BP control was 38.0% in men and 36.1% in women (mean 36.7%). Pre-GHI intervention survey of the facilities yielded control rate of 5% at 3 months, increasing to 29.2% (using 140/90 criteria) post-GHI intervention. Within-person improvements were significant (p<0.001). Difference-in-differences analysis demonstrated net improvements of 16.7 percentage points using 140/90 and 12.9 percentage points using 130/80
Conclusions:
The Ghana Heart Initiative capacity-building programme led to substantial and sustained improvements in BP control Clinical Trial: Ethical approval for the study was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 018/05/19)
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