Hypertension, or high blood pressure, is recognized by the World Health Organization (WHO) as a major public health concern and a leading cause of premature death globally. This non-communicable disease (NCD) is often called a “silent killer” because it typically presents without obvious symptoms, allowing it to cause serious damage over time. The WHO plays a central part in setting the standards for how hypertension is defined, classified, and monitored. Monitoring the condition guides global and national strategies aimed at reducing the burden of heart attacks, strokes, and other associated health issues.
WHO Standards for Defining and Classifying High Blood Pressure
The WHO utilizes a clear and consistent numerical threshold for defining hypertension in adults for large-scale public health surveillance and action. Hypertension is diagnosed if, when measured on two different days, the systolic blood pressure reading is \(\ge 140\) mmHg and/or the diastolic blood pressure reading is \(\ge 90\) mmHg. This single, definitive benchmark provides a uniform standard for countries to identify individuals requiring treatment and to monitor population health trends.
The two numbers in a blood pressure reading represent distinct pressures within the arteries. The systolic number measures the pressure when the heart contracts and pushes blood out. The diastolic number measures the pressure when the heart rests and fills with blood between beats.
To ensure an accurate diagnosis, proper measurement technique is emphasized. Blood pressure naturally fluctuates, so the diagnosis requires multiple readings taken on separate days to confirm a sustained elevation. Factors like using the correct cuff size and ensuring the patient is resting comfortably are important to avoid misclassification.
The WHO’s public health approach generally focuses on this primary cutoff (\(\ge 140/90\) mmHg) for defining the condition. While other global bodies use more detailed classifications, the WHO’s core definition remains the threshold for establishing a diagnosis that requires action in most public health contexts. Sustained pressures that reach \(180/120\) mmHg or higher are considered a hypertensive crisis and can cause severe symptoms like blurred vision and chest pain.
The Global Burden of Hypertension
Hypertension represents the leading metabolic risk factor globally, driving a massive burden of non-communicable diseases worldwide. An estimated 1.4 billion adults aged 30–79 years had hypertension in 2024, affecting roughly one-third of the population in that age range. This makes it a major cause of premature death, responsible for a significant portion of cardiovascular disease-related mortality.
The burden is not evenly distributed across the globe, with distinct geographical and economic disparities. Approximately two-thirds of adults with hypertension live in low- and middle-income countries (LMICs), where the prevalence is generally higher compared to high-income nations. While the prevalence in high-income countries has seen some decline, the number of people affected in LMICs continues to rise.
Hypertension is a major risk factor for several health outcomes, including stroke, heart attack, heart failure, and chronic kidney disease. It accounts for about half of all deaths related to heart disease and stroke globally. A significant challenge is the high rate of undiagnosed cases, with millions of adults unaware they have the condition.
The WHO is committed to reversing these trends through global targets established under the Global Action Plan for the Prevention and Control of NCDs. One key target is a 25% relative reduction in the prevalence of uncontrolled hypertension between 2010 and 2025. Achieving this goal helps reduce the broader target of premature mortality from NCDs by one-third by 2030.
WHO Strategic Approach to Prevention and Control
The WHO’s strategy for tackling hypertension is built on a two-pronged approach that combines population-wide prevention policies with the strengthening of primary health care services. This approach involves implementing high-impact, cost-effective interventions that address the main modifiable risk factors for the condition.
A core policy mechanism is the promotion of the “SHAKE” technical package, which focuses heavily on reducing dietary salt intake at the population level. The goal is to reduce the average population intake of sodium to less than 5 grams per day, a global target set by Member States. Strategies involve mandatory policies like reformulating foods to contain less salt and establishing public food procurement policies that limit salt in institutional settings.
The broader NCD framework also guides the WHO’s recommendations for controlling the behavioral risk factors that contribute to raised blood pressure. This includes implementing policies that discourage tobacco use and the harmful consumption of alcohol, both of which increase hypertension risk. The WHO provides guidance to countries on regulatory, economic, and fiscal instruments, such as taxes and laws, to influence these behaviors.
In addition to dietary and substance control, the strategy strongly promotes increasing physical activity and maintaining a healthy diet globally. The WHO recommends adults engage in at least 150 minutes per week of moderate-intensity aerobic activity to help lower blood pressure. The emphasis on lifestyle counseling, alongside pharmacological treatment, is a cornerstone of the WHO’s non-pharmacological recommendations for hypertension management.
For improving treatment, the WHO advocates for strengthening primary care through the “HEARTS” technical package. This initiative focuses on achieving high rates of blood pressure control through evidence-based treatment protocols and ensuring access to affordable, quality-assured medications. The HEARTS model organizes care around team-based approaches and standardized protocols, demonstrating that successful, large-scale hypertension control is feasible even in resource-limited settings.