Brachial-ankle pulse wave velocity (baPWV) demonstrated superior predictive ability for multi-organ hypertensive damage compared to established cardiovascular risk calculators, with an area under the curve of 0.827 versus 0.466 for standard equations. Among 1,106 Ghanaian adults, 21% showed hypertension-mediated organ damage across multiple systems, rising dramatically to 44% in those over 60. Peripheral artery disease carried the strongest association (41-fold increased odds), followed by valvular disease and ECG changes indicating left ventricular hypertrophy. This preprint study, awaiting peer review, addresses a critical gap in cardiovascular risk assessment for sub-Saharan African populations, where traditional Western-derived risk calculators may underperform. The finding that arterial stiffness measurement substantially improves risk stratification could transform hypertension management in resource-limited settings where early detection of organ damage is crucial. However, the cross-sectional design limits causal interpretation, and the results require validation in other African populations. If confirmed through peer review, baPWV could become a practical screening tool for identifying patients at highest risk for progressive cardiovascular complications, particularly valuable where advanced imaging is unavailable.