Hypertension, a leading risk factor for cardiovascular diseases, has reached alarming prevalence levels globally and in Ghana. This study investigates the behavioral, socio-cultural, and environmental factors influencing the high prevalence of hypertension at the Nkwanta South Municipal Hospital. Cardiovascular diseases, driven largely by hypertension, account for a significant proportion of global mortality. In Ghana, hypertension has emerged as a major public health challenge, contributing substantially to hospital admissions and deaths. The Nkwanta South Municipality, with its unique socio-cultural dynamics, presents a critical case for examining the multifaceted determinants of hypertension. This study aims to identify and analyze the key factors contributing to hypertension prevalence in this region. A cross-sectional descriptive research design was employed, involving 380 respondents from the Nkwanta South Municipality. Data were collected through structured questionnaires focusing on demographic characteristics, behavioral risk factors (e.g., smoking, alcohol consumption, physical activity, dietary habits), socio-cultural influences (e.g., education, employment, income, social support), and environmental factors (e.g., living conditions, healthcare access). Statistical analysis, including descriptive statistics and logistic regression, was conducted using SPSS version 26. The demographic analysis revealed a balanced age distribution, with a higher prevalence of hypertension among individuals aged 30-49. Behavioral factors indicated significant smoking (30%) and alcohol consumption (25%), coupled with low physical activity (40%) and high salt intake (30%). Socio-cultural factors showed that higher education levels correlated with better hypertension management, whereas low income and unemployment were linked to higher prevalence rates. Environmental factors highlighted the urban and suburban residents' higher exposure to hypertension risks compared to their rural counterparts. The study found that behavioral risk factors, such as smoking and unhealthy diets, significantly contribute to hypertension prevalence. Socio-cultural factors, including education and income levels, also play a crucial role in hypertension management and control. Environmental factors, such as living conditions and access to healthcare, further exacerbate the risk of hypertension in urban and suburban areas. The high prevalence of hypertension in the Nkwanta South Municipality is influenced by a complex interplay of behavioral, socio-cultural, and environmental factors. Addressing these determinants requires a multifaceted approach, incorporating public health education, socio-economic interventions, and improved healthcare access. It is recommended that policymakers implement targeted health education campaigns to promote healthy lifestyles, enhance socio-economic support programs to reduce income disparities, and improve healthcare infrastructure to facilitate better hypertension management. Further research is needed to explore the long-term impact of these interventions on reducing hypertension prevalence in similar settings.