Background: Knowledge and understanding of hypertension and its associated health risks remain inadequate despite increasing trend of hypertension prevalence. This study was conducted to assess the prevalence, knowledge and perceptions of hypertension in rural communities in Ghana. Methods: A mixed method study involving 534 subjects was employed. Data was collected in six communities from May to December 2014 with structured questionnaires and interview guides. A logistic regression analysis was conducted to estimate the influence of the socio-demographic factors on knowledge of hypertension. Qualitative data was thematically analyzed. Results: The mean systolic blood pressure (BP) was higher in men than women (127.42mmHg versus 124.42mmHg). The proportion of hypertensives was 21.4% and was higher among men in all age categories. Knowledge on some risk factors of hypertension was extremely low. Having formal education was associated with higher odds of knowledge of hypertension (Adjusted odds ratio [AOR]; 95% confidence interval [CI]=2.28; 1.25-4.16). Several misconceptions such as the use of agro-chemicals, fertilizers and excess vitamins were identified as causes of hypertension. Conclusion: This study demonstrates an increased prevalence of hypertension, knowledge gaps and misconceptions surrounding hypertension in rural communities in Ghana. This evidence is useful in streamlining interventional programmes aimed at improving knowledge and prevention of hypertension.