Non-communicable diseases (NCDs) are a leading global health concern, with77%ofrelated deaths occurring in low- and middle-income countries. In Kenya, hypertension is a major contributor to cardiovascular diseases and a leading cause of morbidity and mortality. The risk of stroke continues to rise, with 1 in 4 individuals expected to experience one in their lifetime (World Stroke Day 2022). This study examined the determinants of blood pressure management among hypertensive patients who developed stroke at Meru Teaching and Referral Hospital (MeTRH), and evaluated current management practices. Using a mixed-methods convergent design, data was collected from80 patients with stroke records (via systematic random sampling), 42 healthcare workers (stratified random sampling), and 10 hypertensive stroke patients (purposive sampling). Tools included medical checklists, structured questionnaires, and in-depth interviews. The study was conducted across MeTRH’s outpatient, medical wards, and non-communicable disease clinics. The results revealed a higher prevalence of hypertension with a complication of stroke among females and older adults (mean age 58.6). Nearly half (47.4%) of healthcare workers (nurses, clinical officer, medical officers, physicians) had under five years of hypertension management experience, and only 18.4% correctly identified the current definition of hypertension, indicating significant knowledge gaps. While 94.7%reportedconducting regular blood pressure screenings and providing lifestyle counselling, patient non-adherence remained a significant barrier—often due to work-related challenges and financial constraints that limited self-care. There was no statistically significant association between healthcare delivery and blood pressure control (p = 0.308). The integration and people centricity of care was outstanding in convergence. Despite consistent screening and counselling efforts, effective blood pressure control remains hindered by limited healthcare provider experience and patient adherence issues. Addressing these gaps is essential for reducing stroke risk and improving hypertension outcomes. The study recommends strengthening clinical practice by introducing structured hypertension counselling at every clinic visit and developing standardized management guidelines. Policymakers should ensure access to essential diagnostics (e.g., ECG, lipid panels) and affordable medications. Follow-up tracking systems for adherence and lifestyle education are also necessary. Community-based support programs or peer-led hypertension clubs are encouraged to promote long-term self-care. Future research should investigate gender-specific and cultural barriers affecting hypertension control.