OBJECTIVES: The goal of this study was to determine the prevalence of hypertension and establish the levels of detection, treatment, and control among urban civil servants in Ghana. METHODS: A cross-sectional study was conducted on 1015 urban civil servants aged > or = 25 years from seven randomly selected central government ministries in Accra, Ghana. Hypertension was diagnosed when the mean of a second and third blood pressure reading was > or = 140/90 mm Hg or participants reported that they used antihypertensive medication. RESULTS: The age-adjusted (world standard population) prevalence of hypertension was 27.4% (95% CI 24.7%-30.1%). The prevalence of hypertension increased with age. The proportion of hypertensive participants with severe hypertension (blood pressure > or = 180/ 110mm Hg) was 19.2%. Among the 307 participants with hypertension, 54.1% had been previously detected, 31.3% were on treatment, and 12.7% had their blood pressure controlled (< 140/90 mm Hg). Female sex was independently associated with higher detection and treatment of hypertension and better control. Hypertension was positively associated with age and body mass index and negatively associated with physical activity. CONCLUSIONS: The high prevalence of hypertension in this population with considerable underdiagnosis and low levels of treatment and control is of great concern. It is important to introduce health education measures that will promote prevention and early detection of hypertension and encourage better compliance to treatment. The reasons for inadequate control must be investigated to enable implementation of appropriate measures to improve control and reduce the risk of developing complications. There is a need to encourage healthier lifestyles with emphasis on preventing obesity and increasing level of activity.