The prevalence of hypertension and other non-communicable diseases has been increasing at an alarming rate in sub-Saharan Africa (SSA) and is disproportionately affected compared to other regions. The Gambia, a low-income and smallest country in mainland Africa, has had only two nationwide surveys on hypertension and related non-communicable diseases (NCDs) in 1996 and 2010 respectively. Issues related to hypertension management such as hypertension care cascade, blood pressure levels by hypertension and treatment status respectively have not been previously evaluated. This thesis investigates the prevalence of hypertension and related NCDs and their associated risk factors and evaluates gaps in the management of hypertension in The Gambia. METHODS: The data for this PhD was collected as part of a nationally representative survey of adults aged 35 years or more. Socio-demographic and economic information, self-reported personal and family health history, as well as information on smoking and alcohol consumption, were collected and used in the analysis for this thesis. Relevant anthropometric data such as height, weight, capillary blood glucose and blood pressure were also collected. Analyses were weighted according to the population distribution of the 2013 Gambia Population and Housing Census and weighted to account for sex, age, and cluster size. RESULTS: The thesis documented very high prevalence rates of hypertension, diabetes, obesity and multimorbidity in Gambian adults. The prevalence rates for all conditions were strongly related to age. There was also very low performance of the cascade of care for hypertension characterised by high proportion of undiagnosed cases, low rates of treatments and very low proportion of those receiving treatment achieving desired blood pressure targets. The thesis also demonstrated that regardless of treatment status, blood pressure levels were high among all individuals with hypertension. Finally, in the investigation of the association between BMI and blood pressure, there was as expected, a positive association. However, there were sex differences in this association with a steeper rise in systolic blood pressure with BMI observed in men and a more gradual increase in women. CONCLUSION: The research findings have broad implications for policy and public health interventions against NCDs. Its calls for a comprehensive multisectoral strategy to reduce the prevalence of NCDs. This includes programmes on health and nutrition education, policies to improve quality of food supply as well as on transportation and environmental design. Better population screening approaches for hypertension to identify undiagnosed cases of hypertension, increasing treatment allocation to reach untreated cases should be devised and implemented. Finally current treatment guidelines should be revisited and strategies to improve treatment adherence reinforced.