Hypertension, also known as high blood pressure, is a condition in which the pressure in the blood vessels is persistently elevated. Blood pressure is expressed as two numbers: systolic blood pressure, which represents the pressure when the heart contracts, and diastolic blood pressure, which represents the pressure when the heart rests between beats.[1]
According to the World Health Organization (WHO), hypertension is diagnosed when blood pressure measured on two different days shows a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg on both days.[1]
Hypertension is a major risk factor for heart disease, stroke, heart failure and kidney disease. It is often referred to as a “silent” condition because most people with hypertension do not experience symptoms and may remain unaware of the condition unless their blood pressure is measured.[1]
Global Impact
Hypertension is one of the leading causes of premature death worldwide. In 2024, an estimated 1.4 billion adults aged 30–79 years were living with hypertension, representing approximately 33% of adults in this age group.[1]
Nearly two-thirds of adults with hypertension live in low- and middle-income countries. Approximately 44% of adults with hypertension are unaware that they have the condition, while only about 23% have their blood pressure under control.[1]
Impact in India
Hypertension represents a major public health challenge in India. WHO estimates indicate that approximately 188.3 million adults aged 30–79 years in India were living with hypertension, with an age-standardized prevalence of approximately 31%.[2]
Among adults with hypertension in India, approximately 37% had been diagnosed, 30% were receiving treatment and only 15% had their blood pressure under control, highlighting substantial gaps in hypertension detection, treatment and control.[2]
Risk Factors
Several modifiable and non-modifiable factors increase the likelihood of developing hypertension.[1]
Modifiable risk factors include high dietary salt intake, diet high in saturated and trans fats, low intake of fruits and vegetables, physical inactivity, tobacco use, harmful use of alcohol, overweight and obesity and exposure to air pollution.[1]
Non-modifiable risk factors include increasing age, family history of hypertension and the presence of conditions such as diabetes or kidney disease.[1]
Signs and Symptoms
Most people with hypertension do not experience any symptoms, making regular blood pressure measurement important for early detection.[1]
When blood pressure becomes very high, symptoms may include:
- Severe headache
- Dizziness
- Blurred vision or other vision changes
- Chest pain
- Difficulty breathing
- Nausea or vomiting
- Confusion or anxiety
- Nosebleeds
- Abnormal heart rhythm.[1]
Very high blood pressure, particularly 180/120 mmHg or higher accompanied by symptoms, requires immediate medical attention.[1]
Complications
If hypertension remains uncontrolled, persistently elevated pressure can damage the heart, blood vessels, brain, kidneys and other organs.[1]
Major complications include:
- Coronary heart disease and heart attack: High blood pressure can damage and harden arteries, reducing blood and oxygen supply to the heart.[1]
- Stroke: Hypertension can contribute to blockage or rupture of blood vessels supplying the brain.[1]
- Heart failure: Persistently high blood pressure increases the workload on the heart and can eventually impair its ability to pump blood effectively.[1]
- Kidney disease: Hypertension can damage blood vessels in the kidneys and may eventually contribute to kidney failure.[1]
- Abnormal heart rhythms: Hypertension can contribute to cardiac changes associated with irregular heart rhythms.[1]
Prevention and Management
Hypertension can often be prevented or controlled through a combination of healthy lifestyle practices, regular blood pressure monitoring and appropriate medication when required.[1]
- Lifestyle Measures: Reducing salt intake, eating more fruits and vegetables, maintaining a healthy body weight, engaging in regular physical activity, avoiding tobacco and limiting alcohol consumption can help prevent and control high blood pressure.[1]
WHO recommends at least 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity activity per week, along with muscle-strengthening activities on two or more days each week.[1]
- Antihypertensive Medication: People whose blood pressure remains elevated despite lifestyle measures, or who have a sufficiently high cardiovascular risk, may require medication. Common classes of antihypertensive medicines include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium-channel blockers and diuretics.[1,3]
Effective management requires regular blood pressure monitoring, adherence to prescribed medicines and management of other cardiovascular risk factors and associated conditions, including diabetes and kidney disease.[1]
WHO HEARTS Technical Package
The WHO HEARTS Technical Package provides a strategic approach to strengthening the prevention and management of cardiovascular disease in primary health care. It supports standardized, evidence-based management of cardiovascular risk factors, including hypertension, and is aligned with the WHO Package of Essential Noncommunicable Disease Interventions (WHO PEN).[4]
The HEARTS package consists of six interconnected components:[4]
- H – Healthy-lifestyle counselling: Counselling and brief interventions to address behavioural cardiovascular risk factors and promote healthy lifestyles.
- E – Evidence-based treatment protocols: Standardized clinical protocols for the management of hypertension and diabetes.
- A – Access to essential medicines and technology: Ensuring availability and appropriate management of essential medicines and technologies for cardiovascular care.
- R – Risk-based CVD management: Assessment and management based on an individual's overall cardiovascular risk.
- T – Team-based care: Use of team-based approaches and task sharing in cardiovascular care.
- S – Systems for monitoring: Standardized indicators and data-collection tools to monitor and improve CVD prevention and management.
For hypertension management, HEARTS emphasizes assessment of total cardiovascular risk, rather than considering blood pressure alone. The WHO CVD risk charts estimate an individual's 10-year risk of a fatal or non-fatal cardiovascular event, taking into account multiple cardiovascular risk factors.[4]
WHO provides both laboratory-based and non-laboratory-based CVD risk charts. Laboratory-based assessment uses age, sex, smoking status, systolic blood pressure, diabetes status and total cholesterol, while non-laboratory assessment uses age, sex, smoking status, systolic blood pressure and body mass index (BMI), allowing risk assessment where laboratory testing is limited.
References
- World Health Organization. Hypertension. Geneva: World Health Organization; 2025 Sep 25. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
- World Health Organization. India: hypertension profile. Geneva: World Health Organization; 2023. Available from: https://cdn.who.int/media/docs/default-source/country-profiles/hypertension/hypertension-2023/hypertension_ind_2023.pdf?sfvrsn=70e972bc_4&download=true
- 3.World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization; 2021 Aug 24. Available from: https://www.who.int/publications/i/item/9789240033986
- 4.World Health Organization. HEARTS: technical package for cardiovascular disease management in primary health care: risk-based CVD management. Geneva: World Health Organization; 2020. Available from: https://iris.who.int/server/api/core/bitstreams/aef55845-a638-45d0-b816-70dd5bf8885a/content