The Hypertension Pandemic: Why High Blood Pressure Is a Global Health Emergency

Hypertension is one of the major causes of the global increase in the burden of diseases. According to reports, 1.28 billion people suffer from hypertension worldwide, yet 46 percent of the adults suffering from it are unaware of their condition. Hypertension, or increased blood pressure, is the most common risk factor for various chronic diseases such as cardiovascular disease, stroke, and kidney disease. It is also one of the primary reasons for premature deaths around the world. According to recent estimates, two-thirds of the people living in low- and middle-income countries suffer from hypertension. Despite the availability of effective screening and treatment protocols, only 1 in 5 adults suffering from this condition can manage it efficiently. These statistics present the need for increased awareness, early diagnosis, and comprehensive management strategies and protocols. The increased incidence of high blood pressure in younger populations poses significant challenges for the public health systems.

What is Hypertension?

Hypertension refers to the persistent increase in blood pressure across the blood vessels. Blood pressure is the ratio of systolic blood pressure over diastolic blood pressure. Systolic blood pressure is the pressure exerted on the walls of the blood vessels during the heart's contraction, and diastolic blood pressure is the pressure exerted during the relaxation of the heart. According to the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, 2027, hypertension is when the systolic blood pressure is 130 mmHg or more and/or the diastolic blood pressure is more than 80 mmHg. According to World Health Organization (WHO) guidelines, high blood pressure is when the blood pressure is 140/90 mmHg or higher.

The American College of Cardiology (ACC) and the American Heart Association (AHA) have classified blood pressure into various stages according to systolic and diastolic blood pressure values. Normal blood pressure is when the systolic blood pressure reading is less than 120 mmHg, and a diastolic blood pressure reading is less than 80 mmHg. The elevated stage is referred to a systolic BP range of 120 to 129 mmHg and a diastolic BP reading under 80 mmHg. Stage 1 hypertension is when the systolic pressure ranges between 130 mmHg and 139 mmHg or the diastolic pressure ranges between 80 mmHg and 89 mmHg. Stage 2 hypertension is when the systolic blood pressure is 140 mmHg or higher; the diastolic blood pressure is 90 mmHg or higher. A hypertensive crisis requires urgent medical attention. A hypertensive crisis is when the systolic blood pressure is over 180 mmHg and/or a diastolic blood pressure reading is over 120 mmHg. This classification of hypertension is globally recognized.

Why is Hypertension a Global Health Emergency?

Hypertension is one of the increasing causes of death every year worldwide, accounting for up to 30% of myocardial infarctions. It is a global health burden that causes over 12.8 percent of the total deaths worldwide. Hypertension also accounts for 57 million DALS/ Disability Adjusted Life Years. Raised blood pressure is a risk factor for various cardiovascular diseases such as coronary heart disease, ischemic heart disease, and hemorrhagic stroke. Hypertension also causes kidney failure, blindness, rupture of blood vessels, and cognitive impairment. The higher the blood pressure, the higher the possibility of potential damage to the heart and blood vessels in major organs such as the brain and kidneys. It accounts for half of all deaths related to heart disease and stroke.

Numerous factors contribute to increased blood pressure in individuals, and these factors are behavioral, social, and metabolic. Various social determinants such as geographic location, age group, and income play a huge role in the likelihood of hypertension. Behavioral risk factors include the consumption of an unhealthy diet containing excessive quantities of salt and fat, not eating enough fruits and vegetables, consumption of tobacco, harmful use of alcohol, physical inactivity, and poor stress management. Metabolic factors such as high cholesterol, diabetes, and obesity increase the risk of hypertension in individuals. These modifiable and non-modifiable risk factors contribute to increased prevalence of the diseases. Additionally, aging populations and socioeconomic disparities exacerbate the risk, particularly in low- and middle-income countries with limited access to quality food and healthcare.

For accurate diagnosis of hypertension, multiple blood pressure readings are taken over several days to account for natural fluctuations and avoid false positive results due to various factors such as stress. The World Health Organization (WHO) recommends taking two consecutive readings recorded at least one minute apart in the morning and evening, with the person seated and relaxed. Blood pressure readings from the first day are discarded, and the diagnosis relies on the average values of the remaining readings. Although the clinical assessments made using validated automatic digital monitors remain the standard, the use of home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) is increasing for their accuracy. HBPM allows a person to take multiple readings in a familiar setting. The ABPM helps identify diseases like masked and white-coat hypertension by detecting 24-hour fluctuations.

Blood pressure readings vary according to the measurement technique, whereas diagnostic criteria are specific to each method. The various devices used to measure blood pressure are electronic, mercury, and aneroid devices. However, the World Health Organization/WHO advises against using devices with mercury due to the risk of mercury toxicity. The World Health Organization/WHO also recommends cost-friendly and reliable electronic devices that enable the option to select manual readings. Semi-automatic devices help in taking manual readings in resource-constrained areas. The Aneroid devices include sphygmomanometers. The use of these devices requires calibration every six months and trained personnel. According to the current diagnostic blood pressure thresholds, office-based hypertension is when the threshold value is 140/90 mmHg or more. In-home blood pressure monitoring (HBPM), the diagnosis of hypertension can be made if the readings are consistently 135/85 mmHg or more. With 24-hour ambulatory monitoring, hypertension is diagnosed based on one of three criteria: 24-hour average BP of 130/80 mm Hg or greater, daytime average BP of 135/85 mm Hg or greater, or nighttime average BP of 120/70 mm Hg or greater.

Hypertension, often regarded as the 'silent killer,' has become a global pandemic as it is widespread, underdiagnosed, asymptomatic, and usually hidden, with devastating long-term consequences. Patients are usually unaware that they have increased blood pressure, as it does not present with any symptoms, and this can result in improper diagnosis and treatment. Hence, regular blood pressure screenings are essential. Otherwise, elevated blood pressure further progresses into various hypertension-associated diseases such as stroke and kidney or heart failure and is only then detected. The World Health Organization/ WHO recommends self-monitoring of hypertension in places where the devices are cheap and affordable. Self-care can facilitate the early detection of hypertension. It also contributes to timely medication, increased awareness, and lifestyle modification to manage the condition better. Self-care is crucial in regions and communities with limited access to health services because of geographic, physical, or economic reasons.

What is the Social and Economic Impact of Hypertension?

Hypertension exerts a grave burden on healthcare systems globally through direct screening and treatment costs, as well as expenses for the management of various complications like cardiovascular diseases, stroke, and kidney failure on a long-term basis. According to the latest reports, nearly half of the population of America suffers from hypertension. This condition is one of the nation’s costliest yet preventable as well as treatable risk factors for cardiac disease and stroke. Over 3 in 4 adults with raised blood pressure do not have it managed. According to statistics, annual costs associated with hypertension account for 2019 billion dollars in America. Although high blood pressure is a major preventable risk factor for cardiovascular diseases, one in eight dollars is spent on the management of these diseases. Globally, there has been a two-fold rise in the number of people with hypertension since 1990. The growing burden of hypertension is mainly in low and middle-income countries than in high-income countries.

Hypertension imposes a significant economic burden at the microeconomic and macroeconomic levels. For individuals and their families, the ongoing costs of managing high blood pressure, including the cost of medicines, regular hospital visits, screening tests, and treatment for various hypertension-related complications like cardiovascular diseases and kidney failure, can lead to increased financial strain, especially in regions with poor health facilities. At the organizational level, hypertension reduces productivity through increased absenteeism, reduced work capacity, and premature retirement, leading to hypertension-related productivity losses. The economic burden extends to increased costs related to healthcare, decreased labor output, and reduced gross national product. In nations with increased hypertensive patients, immense costs associated with the disease continue to overload fragile health systems, especially in underserved regions. For example, in China, over 270 million people suffer from hypertension, yet only 13.8% of them have it under control, and not everyone has access to treatment. The economic burden of hypertension has surpassed many other chronic diseases, and the cost associated with it is 114.5 billion dollars. These numbers depict the critical need for public health interventions and policy strategies that focus on early diagnosis and prevention of hypertension to prevent its global economic impact.

How to Prevent the Global Rise of Hypertension?

Regular measurement of blood pressure is essential for the management of hypertension. Along with this, driving necessary lifestyle changes is crucial for lowering the incidence of hypertension and managing it effectively. The World Health Organization (WHO) recommends consuming a healthy diet with low salt content, quitting tobacco use, getting physical activity, and losing weight. The recommended dosage of salt consumption in adults is less than 5 grams per day, and for children aged 2-15 years, the dosage is adjusted based on the energy requirements. WHO also recommends using iodized salts and replacing regular table salt with other low-sodium salt substitutes. According to research, a reduction in the consumption of 4.4 grams of salt per day led to a decrease of 4.18 mmHg of systolic blood pressure in individuals suffering from hypertension. The Dietary Approaches to Stopping Hypertension (DASH Diet) focuses on lowering blood pressure through dietary changes. This diet is rich in fruits and vegetables and contains low-fat dairy foods. The diet is also low in cholesterol, saturated, and total fats. The DASH diet helps manage blood pressure, especially in hypertensive patients, by limiting the sodium intake to 1500mg daily. Along with the substantial reduction in blood pressure levels, it also lowers cholesterol levels.

The World Health Organization (WHO) and global cardiovascular guidelines recommend routine physical activity, aiming for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous aerobic activity to keep blood pressure values in check. Smoking tobacco impairs cellular function and elevates blood pressure levels. It also reduces the efficacy of medications used to treat hypertension. Hence, quitting smoking is highly essential. Inconsistent sleep cycles disrupt blood pressure homeostasis, and uncontrolled stress activates hormonal pathways that elevate blood pressure. Addressing these factors is therefore necessary for managing hypertension effectively. Restricting alcohol consumption is crucial as it significantly accelerates the progression of hypertension and raises the risk of cardiovascular complications in the long term. Dietary and lifestyle modifications are cost-efficient interventions with minimal side effects. Moreover, with the rising prescription of antihypertensive drugs by medical practitioners, the role of non-pharmacological intervention is often underestimated. It is crucial to understand that non-pharmacological interventions are essential in the prevention of hypertension and the delay of the complications associated with it. A holistic approach involving both pharmacological management strategies along with diet and lifestyle changes is required to tackle hypertension.

Why Should Hypertension be Deemed a Global Health Priority?

Dealing with hypertension requires strict policy forms that go beyond changes within an individual. The WHO released new guidelines for the pharmacological management of hypertension in adults. It has recommendations for the treatment of hypertension, recommended intervals for follow-up, the target blood pressure for control, and information on the concerned healthcare providers. The WHO and the United States Centers for Disease Control and Prevention (U.S. CDC) have also launched the Global Hearts Initiative, featuring a technical package. The package contains guidelines for a healthy lifestyle, treatment protocols, access to the required medicines, risk-based management, and various other approaches to offer strategic interventions to improve cardiovascular health globally. WHO, in partnership with Resolve to Save Lives, has initiated another program to support the implementation of the Global Hearts Initiative. This program has been implemented in 31 low- and middle-income regions where 7.5 million people have been placed on hypertension treatment based on protocols through people-centered care models. These programs exhibit the effectiveness of standardized hypertension control programs.

Several countries have adopted comprehensive and multilevel strategies to lower the incidence rates of hypertension and keep this condition under control in large masses of the population. Korea has commonly used a dual combination antihypertensive therapy for the management of hypertension. Korean Society of Hypertension guidelines have also recommended the frequent use of home blood pressure monitoring (HBPM). The control rate after treatment in hypertensive patients is 70%, highlighting that adherence to therapy is crucial for better management of hypertension. South Korea has also implemented a National Plan to Reduce Sodium Intake. The plan includes awareness regarding food consumption, a rise in the availability of low-sodium foods at schools and workplaces, and altering processed foods to lower sodium content. It also included monitoring and evaluation of sodium intake and sources of dietary sodium using the Korea National Health and Nutrition Examination Survey. This led to a reduction in dietary sodium consumption among adults in South Korea by 23.7%. It also led to a decline in the prevalence rates of hypertension in the population. Another approach was to emphasize urban planning and infrastructure to promote healthy lifestyles. Investments in green spaces, safe pedestrian pathways, and public fitness facilities have encouraged physical activity, as it is a proven non-pharmacological strategy for lowering blood pressure.

Meanwhile, Ghana's approach highlights the efficacy of task-shifting models in low-resource regions. The Task Shifting Strategy for Hypertension (TASSH) is a widespread delivery approach delivered by community health nurses (CHNs) for health interventions targeting prevention, treatment, and control of hypertension in adult populations. This approach focused on shifting the primary care duties from physicians to other healthcare providers. It led to 1.34 times greater systolic blood pressure reduction than the provision of health insurance. The UK has initiated public health reforms by mandating industry compliance with sodium reduction targets and clear front-of-pack nutrition labeling to control hypertension. The population's salt intake decreased by 15% due to the 20–40% reduction in the salt content of processed food based on the targets. The salt reduction strategy also resulted in a significant lowering in blood pressure and a decline in mortality rates due to the complications of hypertension, such as stroke and ischemic heart disease. They initiated another strategy of community health and well-being workers (CHWW) to improve access to healthcare, especially in deprived populations. These community-based services aid in the effective management of hypertension and prevent the need for urgent care response. This proactive initiative ensures a well-coordinated and multicentered approach to managing hypertension.

Hence, despite being preventable and manageable, hypertension remains one of the most crucial global health challenges. It silently drives premature mortality and disability, particularly in low- and middle-socioeconomic regions where there is limited access to screening and long-term care. The prevalence of the disease not only burdens individuals and their families but also weakens economies and health systems struggling to manage the adverse effects of uncontrolled blood pressure. The solutions are based on evidence and have proven to be cost-effective. They exist at the primary care level, from early diagnosis and fixed-dose combination therapies to task-shifting and community-based models of care. Countries that have incorporated these strategies have achieved dramatic improvements in population-level control. The global community can no longer afford to ignore what experts call a “silent killer.” Making hypertension a global health priority through strong political will, integrated care delivery, and investment in prevention is one of the most impactful and scalable ways to reduce premature death and achieve global health equity. Addressing hypertension is not a vertical program. It is a foundational investment in resilience, equity, and the future of global health. Whether we can act or not is no longer the question. It is how quickly we are ready to act before the burden of hypertension increases on a global scale.

Sources:

1. World Health Organization. Hypertension. Published March 16, 2023. Accessed April 15, 2025. https://www.who.int/news-room/fact-sheets/detail/hypertension

2. Oparil S, Acelajado MC, Bakris GL, et al. Hypertension. Nat Rev Dis Primers. 2018;4:18014. doi:10.1038/nrdp.2018.14

3. Iqbal AM, Jamal SF. Essential hypertension. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Updated July 20, 2023. Accessed April 15, 2025. https://www.ncbi.nlm.nih.gov/books/NBK539859/

4. American Heart Association. Understanding blood pressure readings. Accessed April 15, 2025. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

5. LeFevre ML. Hypertension: New guidelines from the International Society of Hypertension. Am Fam Physician. 2021;103(12):763-765. Accessed April 15, 2025. https://www.aafp.org/pubs/afp/issues/2021/0615/p763.html

6. World Health Organization. Indicator metadata registry: Blood pressure/hypertension. Accessed April 15, 2025. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3155

7. World Heart Federation. Hypertension. Accessed April 15, 2025. https://world-heart-federation.org/what-we-do/hypertension/

8. World Health Organization. A global brief on hypertension: Silent killer, global public health crisis. Geneva: World Health Organization; 2013. Accessed April 15, 2025. https://iris.who.int/bitstream/handle/10665/79059/WHO_DCO_WHD_2013.2_eng.pdf

9. Centers for Disease Control and Prevention. Health and economic benefits of high blood pressure interventions. Accessed April 15, 2025. https://www.cdc.gov/nccdphp/priorities/high-blood-pressure.html

10. Zhao D, Liu J, Wang M, et al. Global, regional, and national burdens of hypertensive heart disease from 1990 to 2019: A systematic analysis of the Global Burden of Disease Study 2019. Lancet Glob Health. 2023;11(4):e456-e467. doi:10.1016/S2405-8440(23)00979-1

11. World Health Organization. More than 700 million people with untreated hypertension. Published August 25, 2021. Accessed April 15, 2025. https://www.who.int/news/item/25-08-2021-more-than-700-million-people-with-untreated-hypertension

12. Institute of Medicine (US) Committee on Public Health Priorities to Reduce and Control Hypertension. A population-based policy and systems change approach to prevent and control hypertension. Washington (DC): National Academies Press (US); 2010. Accessed April 15, 2025. https://www.ncbi.nlm.nih.gov/books/NBK220098/

13. World Health Organization. Hypertension in China. Accessed April 15, 2025. https://www.who.int/china/health-topics/hypertension

14. VELL, LLC. Hypertension economic burden. Published May 7, 2024. Accessed April 15, 2025. https://vellhealth.com/hypertension-economic-burden/

15. Alcocer L, Cueto L. Review: Hypertension, a health economics perspective. Ther Adv Cardiovasc Dis. 2008;2(3):147–155. doi:10.1177/1753944708090572

16. World Health Organization. Sodium reduction. Published February 7, 2025. Accessed April 15, 2025. https://www.who.int/news-room/fact-sheets/detail/sodium-reduction

17. He FJ, Li J, MacGregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013;346:f1325. doi:10.1136/bmj.f1325

18. Heart and Stroke Foundation of Canada. DASH diet. Accessed April 15, 2025. https://www.heartandstroke.ca/healthy-living/healthy-eating/dash-diet

19. Centers for Disease Control and Prevention. Managing high blood pressure. Published December 13, 2024. Accessed April 15, 2025. https://www.cdc.gov/high-blood-pressure/living-with/index.html

20. Saleem K, Haq I-U, Abdi G, Rabail R, Aadil RM. Dietary and lifestyle modifications for effective management of hypertension: A comprehensive review. J Agric Food Res. 2025;20:101750. doi:10.1016/j.jafr.2025.101750

21. Carey RM, Muntner P, Bosworth HB, Whelton PK. Prevention and control of hypertension: JACC health promotion series. J Am Coll Cardiol. 2018;72(11):1278–1293. doi:10.1016/j.jacc.2018.07.008

22. World Health Organization. HEARTS: Technical package for cardiovascular disease management in primary health care: Risk-based CVD management. Geneva: World Health Organization; 2020. Accessed April 15, 2025. https://www.who.int/publications/i/item/hearts-technical-package

23. World Health Organization. WHO global sodium benchmarks for different food categories. Geneva: World Health Organization; 2021. Accessed April 15, 2025. https://www.who.int/publications/i/item/9789240025097

24. Kim HC, Lee H, Lee HH, et al. Korea hypertension fact sheet 2023: Analysis of nationwide population-based data with a particular focus on hypertension in special populations. Clin Hypertens. 2024;30(1):7. doi:10.1186/s40885-024-00262-z

25. Akinosun AS, Olamoyegun MA, Ogunlana MO, et al. Determining the frequency and level of task-sharing for hypertension management in low- and middle-income countries: A systematic review and meta-analysis. eClinicalMedicine. 2022;45:101314. doi:10.1016/j.eclinm.2022.101314

26. Blackstone S, Iwelunmor J, Plange-Rhule J, et al. Sustaining nurse-led task-shifting strategies for hypertension control: A concept mapping study to inform evidence-based practice. Worldviews Evid Based Nurs. 2017;14(5):350–357. doi:10.1111/wvn.12230

27. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: A pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–980. doi:10.1016/S0140-6736(21)01330-1

28. Asante KP, Iwelunmor J, Apusiga K, et al. Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: Study protocol for a cluster randomized controlled trial. Trials. 2020;21(1):825. doi:10.1186/s13063-020-04667-7

29. Iwelunmor J, Onakomaiya D, Gyamfi J, et al. Adopting task-shifting strategies for hypertension control in Ghana: Insights from a realist synthesis of stakeholder perceptions. Global Heart. 2019;14(2):103–109. doi:10.1016/j.gheart.2019.05.001

30. Park H-K, Lee Y, Kang B-W, et al. Progress on sodium reduction in South Korea. BMJ Global Health. 2020;5(5):e002028. doi:10.1136/bmjgh-2019-002028

31. United Nations Development Programme. Universal health coverage for the people of the Republic of Korea. Published August 2020. Accessed April 15, 2025. https://www.undp.org/sites/g/files/zskgke326/files/migration/seoul_policy_center/3fbe93ea6be39c90b6e7454833a44ee66e0356afdb5309f5596825467a3ad937.pdf

32. Department of Health and Social Care. Front of pack nutrition labelling guidance. Published September 2019. Accessed April 15, 2025. https://www.gov.uk/government/publications/front-of-pack-nutrition-labelling-guidance

33. Action on Salt. Action on Salt policy position: UK salt reduction strategy. Published October 2018. Accessed April 15, 2025. https://www.actiononsalt.org.uk/media/action-on-salt/about/FINAL-Action-on-Salt-Policy-Brief.pdf

34. Campbell D. Health workers sent door to door in deprived areas to detect illnesses. The Guardian. April 8, 2025. Accessed April 15, 2025. https://www.theguardian.com/society/2025/apr/08/health-workers-sent-door-to-door-in-deprived-areas-to-detect-illnesses

35. Frieden TR, Varghese CV, Kishore SP, et al. Scaling up effective treatment of hypertension—A pathfinder for universal health coverage. J Clin Hypertens (Greenwich). 2019;21(10):1442–1449. doi:10.1111/jch.13655

36. Allen CG, Brownstein JN, Satsangi A, Escoffery C. Community health workers as allies in hypertension self-management and medication adherence in the United States, 2014. Prev Chronic Dis. 2016;13:E179. doi:10.5888/pcd13.160236

37. Global Health 50/50. The Global Health 50/50 Report 2025: A global survey of gender equality in health policy and practice. Published February 15, 2025. Accessed April 15, 2025. https://globalhealth5050.org/2025-report