Multidomain Hypertension-Mediated Organ Damage in Ghanaian Adults: Prevalence, Predictors, and Implications for Cardiovascular Risk Stratification — A Secondary Analysis of the Ghana Heart Study

Abstract

Abstract Background Comprehensive assessment of hypertension-mediated organ damage (HMOD) across multiple organ systems remains limited in sub-Saharan Africa. We aimed to determine the prevalence and predictors of multidomain HMOD in a geographically diverse Ghanaian adult population. Methods This secondary analysis of the Ghana Heart Study included 1,106 adults from four Ghanaian regions. Multidomain HMOD was defined as a pre-specified 9-domain composite score ≥2, constructed according to the ESH/ESC 2018 hypertension guidelines framework. 27 Logistic regression and ROC analysis identified predictors and compared discriminative performance across vascular, cardiac, ECG, valvular, and renal domains. Results Mean age was 46.9 ± 17.2 years (58% female). Multidomain HMOD prevalence was 21.2% (235/1,106) and increased steeply with age: 8.6% in adults <45 years, 20.6% in those 45–59 years, and 44.4% in those ≥60 years. The HMOD-positive group was older (59.1 vs. 43.6 years), had higher systolic BP (147 vs. 123 mmHg), and higher hypertension prevalence (73% vs. 28%, all p<0.001). In adjusted models, the strongest associations were peripheral artery disease (OR 41.2, 95% CI 20.7–81.6), valvular burden (OR 14.4, 95% CI 4.8–43.8), and ECG-LVH (OR 9.0, 95% CI 5.9–13.8). baPWV demonstrated superior discriminative performance (AUC 0.827, 95% CI 0.794–0.860) compared with the ASCVD Pooled Cohort Equations (AUC 0.466; ΔAUC +0.351, DeLong test p<0.001). The metabolic syndrome triad was present in 13.4% and independently associated with multidomain HMOD (adjusted OR 2.11, 95% CI 1.28–3.49, p=0.004). Conclusions One in five Ghanaian adults has hypertension-mediated organ damage in ≥2 organ systems. baPWV is the strongest predictor and substantially improves risk stratification beyond conventional risk scores, supporting its use to guide hypertension management and HMOD assessment in West Africa.