Hypertension
Hypertension is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself, yet it remains a major risk factor for stroke, coronary artery disease, heart failure, and chronic kidney disease. About 90 to 95 percent of cases are primary hypertension, defined as high blood pressure due to non-specific lifestyle and genetic factors. The remaining 5 to 10 percent of cases are categorized as secondary hypertension, caused by clearly identifiable issues like chronic kidney disease or endocrine disorders. For most adults, normal blood pressure at rest falls within the range of 100 to 140 millimeters mercury systolic and 60 to 90 mmHg diastolic. High blood pressure is present if resting blood pressure persists at or above 130/80 or 140/90 mmHg.
Primary hypertension results from a complex interaction of genes and environmental factors. More than 2000 common genetic variants with small effects on blood pressure have been identified alongside some rare genetic variants with large effects. Blood pressure rises with aging in societies with a western diet and lifestyle, making the risk substantial in later life. Reducing dietary salt intake lowers blood pressure, while increasing alcohol intake is associated with higher levels. Depression is linked to hypertension, and loneliness serves as another risk factor. Air pollution exposure correlates with elevated blood pressure, though causality remains unknown. Events in early life, such as low birth weight or maternal smoking, may be weak risk factors for adult essential hypertension.
Lifestyle changes form the first line of treatment including dietary adjustments, physical activity, and weight loss. Effective lifestyle modification can lower blood pressure as much as an individual antihypertensive medication alone. First-line medications include thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers. Most people require more than one medication to control their hypertension effectively. Up to three medications taken concurrently can control blood pressure in 90 percent of people. Resistant hypertension is defined as high blood pressure remaining above target levels despite prescribed three or more drugs simultaneously. Failing to take prescribed medications as directed remains an important cause of resistant cases.
In 2024, one in three or 33 percent of the world population were estimated to
have hypertension. Almost half of all people with hypertension do not know that they have it. In 1990, about 650 million people had a diagnosis of hypertension, which increased to 1.4 billion by 2024 due largely to rising numbers of older adults in low- and middle-income countries. Hypertension rates are highest in Africa at 30 percent for both sexes and lowest in the Americas at 18 percent. Country-level rates vary from 22.8 percent in Peru to over 61 percent in Paraguay. African-American adults in the United States show among the highest rates globally at 44 percent, though other research suggests Eastern Europeans may have markedly higher
rates.
Modern understanding of the cardiovascular system began with physician William Harvey who described blood circulation in his book De motu cordis published between 1578 and 1657. The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733. Hypertension as a clinical entity came into its own with the invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896. Nikolai Korotkoff improved the technique in 1905 by describing sounds heard when the artery is auscultated while the cuff deflates. Until the 1990s, systolic hypertension was defined as 160 mmHg or greater before WHO guidelines shifted the threshold to 140 mmHg in 1993.
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Common questions
What is hypertension and how does it affect the body?
Hypertension is a long-term medical condition in which blood pressure in the arteries remains persistently elevated. It serves as a major risk factor for stroke, coronary artery disease, heart failure, and chronic kidney disease.
How many people had hypertension globally in 2024 and where are rates highest?
In 2024, one in three or 33 percent of the world population were estimated to have hypertension. Hypertension rates are highest in Africa at 30 percent for both sexes and lowest in the Americas at 18 percent.
When was the first measurement of blood pressure recorded by Stephen Hales?
The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733. This event marked an early step before Scipione Riva-Rocci invented the cuff-based sphygmomanometer in 1896.
What defines normal blood pressure levels for most adults today?
For most adults, normal blood pressure at rest falls within the range of 100 to 140 millimeters mercury systolic and 60 to 90 mmHg diastolic. High blood pressure is present if resting blood pressure persists at or above 130/80 or 140/90 mmHg.
Why do some cases of hypertension remain resistant to treatment with multiple medications?
Resistant hypertension is defined as high blood pressure remaining above target levels despite prescribed three or more drugs simultaneously. Failing to take prescribed medications as directed remains an important cause of these resistant cases.