What is hypertension?

Hypertension is defined by WHO as a systolic blood pressure of 140 mmHg or above, or a diastolic blood pressure of 90 mmHg or above, or both — measured on two separate occasions. It forces the heart to work harder, damages arterial walls and is the leading modifiable cause of heart attack, stroke, heart failure and kidney failure globally.

Why is hypertension called the "silent killer"?

Hypertension almost never causes symptoms until it triggers a catastrophic event — a heart attack, stroke or acute kidney failure. People can have dangerously elevated blood pressure for years and feel entirely well. This is why screening is essential: blood pressure measurement is the only way to detect it.

Who should get their blood pressure checked?

WHO recommends that all adults get their blood pressure checked at least every 5 years, and at least annually for anyone with a risk factor (overweight, family history, high salt diet, diabetes, kidney disease, age over 40). Blood pressure is measured easily, painlessly and cheaply. Regular screening and early treatment can prevent the vast majority of hypertension-related complications.

How is hypertension treated?

Lifestyle changes are first-line for mild hypertension: reducing salt intake (to <5g/day), losing excess weight, regular physical activity (150+ min/week), limiting alcohol and stopping smoking. When lifestyle changes are insufficient, antihypertensive medicines are highly effective. First-line classes include ACE inhibitors, ARBs, calcium channel blockers and thiazide diuretics — all cheap generics available in essential medicines lists.

What blood pressure level requires treatment?

Current major guidelines (WHO, ESC, AHA) recommend initiating antihypertensive treatment at >=140/90 mmHg for most adults, and considering treatment at 130/80 mmHg for those at high cardiovascular risk (established CVD, diabetes, kidney disease). The treatment target for most people is below 130/80 mmHg. For older adults, targets may be modified to avoid hypotension risk.

How much does salt reduction lower blood pressure?

Reducing daily salt intake by 5g (roughly 1 teaspoon) lowers systolic blood pressure by approximately 3-6 mmHg — enough to reduce stroke risk by 14% and heart attack risk by 9% at a population level. The WHO target is <5g/day; most people consume 9-12g. Processed and restaurant food contributes 75% of dietary salt in high-income countries, making food industry engagement essential alongside individual action.

What is resistant hypertension?

Resistant hypertension is blood pressure that remains above target despite concurrent use of 3 antihypertensive medicines at optimal doses (one of which should be a diuretic). It affects 10-15% of treated patients and requires specialist evaluation to exclude secondary causes (renal artery stenosis, primary aldosteronism, sleep apnoea) and optimise adherence. Renal denervation is an emerging device-based option for selected patients.

How does hypertension damage the kidneys?

Chronically elevated blood pressure damages the small blood vessels that supply the glomeruli — the kidney's filtering units. This causes nephrosclerosis: gradual scarring and loss of kidney function. Hypertension is the second leading cause of end-stage kidney disease (after diabetes). Conversely, kidney disease causes hypertension through fluid retention and hormonal mechanisms — creating a vicious cycle that requires combined management.

What is the SPRINT trial?

The Systolic Blood Pressure Intervention Trial (SPRINT, 2015, NEJM) found that targeting systolic BP below 120 mmHg (vs 140 mmHg) in adults over 50 with high cardiovascular risk reduced major cardiovascular events by 25% and all-cause mortality by 27%. This trial substantially influenced guidelines towards more intensive treatment targets in high-risk patients, though the evidence for routine patients at lower risk is more nuanced.

Why is hypertension control so poor globally?

Despite being easily diagnosable and treatable with cheap medicines, only 21% of adults with hypertension have it controlled. Barriers include: low awareness (people do not get screened); poor access to primary care; medicine supply chain failures; cost of medicines and visits; side effects causing non-adherence; and health system fragmentation. The WHO HEARTS package addresses all these barriers through simplified protocols and community-based delivery.

How does hypertension differ between sexes?

Before menopause, women generally have lower blood pressure than men of the same age. After menopause, blood pressure rises more steeply in women, and hypertension prevalence becomes roughly equal. Women are less likely to receive guideline-recommended intensive treatment. Hypertension in pregnancy — including pre-eclampsia and eclampsia — is a distinct and particularly dangerous form covered in the maternal health section.

How does GMJ News cover hypertension?

GMJ News tracks WHO HEARTS implementation, SPRINT and related trial updates, salt reduction policy and the global blood pressure control gap. Georgia has very high cardiovascular mortality with hypertension as a primary driver — a direct public health priority for PHIG, the Georgian Medical Journal and Georgia's national NCD action plan.

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Hypertension

Q: What blood pressure level requires treatment?

Current major guidelines (WHO, ESC, AHA) recommend initiating antihypertensive treatment at >=140/90 mmHg for most adults, and considering treatment at 130/80 mmHg for those at high cardiovascular risk (established CVD, diabetes, kidney disease). The treatment target for most people is below 130/80 mmHg. For older adults, targets may be modified to avoid hypotension risk.

Q: What is resistant hypertension?

Resistant hypertension is blood pressure that remains above target despite concurrent use of 3 antihypertensive medicines at optimal doses (one of which should be a diuretic). It affects 10-15% of treated patients and requires specialist evaluation to exclude secondary causes (renal artery stenosis, primary aldosteronism, sleep apnoea) and optimise adherence. Renal denervation is an emerging device-based option for selected patients.

Q: How does hypertension damage the kidneys?

Chronically elevated blood pressure damages the small blood vessels that supply the glomeruli — the kidney's filtering units. This causes nephrosclerosis: gradual scarring and loss of kidney function. Hypertension is the second leading cause of end-stage kidney disease (after diabetes). Conversely, kidney disease causes hypertension through fluid retention and hormonal mechanisms — creating a vicious cycle that requires combined management.

Q: What is the SPRINT trial?

The Systolic Blood Pressure Intervention Trial (SPRINT, 2015, NEJM) found that targeting systolic BP below 120 mmHg (vs 140 mmHg) in adults over 50 with high cardiovascular risk reduced major cardiovascular events by 25% and all-cause mortality by 27%. This trial substantially influenced guidelines towards more intensive treatment targets in high-risk patients, though the evidence for routine patients at lower risk is more nuanced.

Q: Why is hypertension control so poor globally?

Despite being easily diagnosable and treatable with cheap medicines, only 21% of adults with hypertension have it controlled. Barriers include: low awareness (people do not get screened); poor access to primary care; medicine supply chain failures; cost of medicines and visits; side effects causing non-adherence; and health system fragmentation. The WHO HEARTS package addresses all these barriers through simplified protocols and community-based delivery.

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Hypertension is the world's leading modifiable risk factor for death: an estimated 1.28 billion adults aged 30–79 have raised blood pressure, and almost half are unaware of it (WHO). Only about one in five has it under control, yet inexpensive generic medicines and protocol-based care — the WHO HEARTS approach — can prevent a large share of strokes, heart attacks and kidney failure. The first WHO Global Report on Hypertension (2023) calls control coverage one of the best buys in global health.

Key messages

Silent killer

Hypertension — persistently elevated blood pressure — has no symptoms until it causes a heart attack, stroke or kidney failure, earning its name "the silent killer." More than 1.28 billion adults worldwide have it.

Majority unaware

Fewer than half of people with hypertension know they have it (WHO 2021). Of those diagnosed, only about 42% are on treatment — and only 21% have their blood pressure controlled.

Primary risk factor

High blood pressure is the single most important modifiable risk factor for cardiovascular disease and premature death globally — responsible for 10.8 million deaths per year.

Prevention

Reducing salt intake, increasing physical activity, maintaining a healthy weight, limiting alcohol and stopping smoking can all reduce blood pressure. These lifestyle changes can prevent or delay the need for medicines.

Treatment is effective

Blood-pressure-lowering medicines are among the most cost-effective health interventions ever identified. A 10 mmHg reduction in systolic blood pressure reduces heart attack risk by 20% and stroke by 27%.

Equity

Two thirds of people with hypertension live in LMICs, where access to diagnosis and treatment is weakest. Essential antihypertensives cost less than $1/month; the barrier is health system access, not drug price.

Key statistics

1.28B

adults with hypertension

WHO 2021

<50%

know they have it

WHO 2021

10.8M

deaths attributed/year

GBD

21%

achieving blood pressure control

WHO 2021

2/3

of cases in LMICs

WHO 2021

modifiable CVD risk factor

WHO

Global hypertension prevalence in adults (%) 2000-2019 — WHO estimates

Source: WHO global estimates. Age-standardised prevalence of raised blood pressure (>=140/90 mmHg).

Glossary of key terms

Systolic blood pressure
WHO/AHAThe pressure in arteries when the heart beats — the top number in a blood pressure reading. Hypertension is defined as systolic >=140 mmHg or diastolic >=90 mmHg.

Diastolic blood pressure
WHO/AHAThe pressure in arteries between heartbeats — the bottom number. Isolated diastolic hypertension is common in younger adults; isolated systolic hypertension is more common in older adults.

Essential hypertension
WHOHigh blood pressure with no identifiable cause — accounting for 90-95% of all hypertension. Also called primary hypertension. Caused by a combination of genetic, lifestyle and environmental factors.

White coat hypertension
ESCElevated blood pressure in a clinical setting that is normal at home. Affects 15-30% of people diagnosed with hypertension. Home blood pressure monitoring and 24-hour ambulatory monitoring help distinguish it from true hypertension.

Target organ damage
ESC/WHODamage to organs caused by chronic hypertension — including left ventricular hypertrophy (heart), nephrosclerosis (kidneys), retinopathy (eyes) and atherosclerosis (blood vessels). Screening for target organ damage guides treatment intensity.

WHO HEARTS
WHOA technical package for cardiovascular disease management in primary care that includes a hypertension-specific module — simple, single-pill treatment protocols designed for low-resource settings.