The Silent Killer: Understanding the Burden of Hypertension

Thank you for reading my latest article, The Silent Killer: Understanding the Burden of Hypertension. You may also find Hypertension, the Silent Killer: A Journey Through History useful. I frequently share insights on healthcare, healthcare innovations, and healthcare education. To stay updated with my future articles, simply click 'Subscribe' to my newsletter, World of Health.

When I first encountered hypertension (high blood pressure) in medical school, it didn’t roar—it whispered. I remember walking through the crowded inpatient wards of Tikur Anbessa Specialized Hospital, seeing patients whose lives had quietly unraveled. One man had come in after a massive stroke. Another had been losing his vision for months. A third was in kidney failure. The common thread? Uncontrolled high blood pressure—undiagnosed, untreated, and deadly.

That was when I began to understand why hypertension is called the "silent killer." It does not announce itself with pain or fever. It doesn’t force you into bed or leave visible scars. Instead, it lingers in the background—quietly damaging arteries, burdening the heart, and overwhelming organs.

Yet its silence is deceptive. Today, hypertension is the leading risk factor for heart disease, stroke, and premature death worldwide. According to the World Health Organization, more than 1.3 billion people live with high blood pressure. In the US alone, high blood pressure affects almost 50% of all adults. Alarmingly, nearly half don’t know they have it. And of those diagnosed, many don’t have it under control. While only 24% of adults living with hypertension in the US have it under control, as high as 90% of people with high blood pressure don’t have it under control in many low-and middle-income countries putting them at serious risk for heart attack and stroke.The burden is global, but it hits hardest in low- and middle-income countries, where access to care, medications, and awareness remains limited.

A Global Strain on Human Health

Imagine this: you’re carrying around a pressure cooker all day, every day. It builds heat slowly. You don’t notice at first—just a little more fatigue, a bit of a headache. But over time, it wears down the system. That’s what high blood pressure does to the body.

It stiffens arteries, enlarges the heart, and doubles, even triples, your risk for cardiovascular events. It's estimated that 10 million deaths each year are linked to hypertension and its complications - almost 20 people every minute. It doesn’t discriminate by country or income—but poverty and inequity amplify its toll.

In sub-Saharan Africa, where I am from, the situation is even more dire. Studies have shown that awareness is low, and treatment rates are lower still. People often seek care only when complications have already set in. A heart attack. A stroke. A collapse. Prevention, not crisis, should be the focus—but we’re not there yet.

Why Is It So Hard to Control?

There are several reasons. First, hypertension is mostly asymptomatic. You don’t feel it until something breaks. That makes routine screening essential—but in many places, there’s no system for that.

Second, there’s the issue of treatment adherence. Even when diagnosed, patients may not take their medications consistently. The reasons vary—side effects, cost, mistrust, or simply not understanding the stakes.

Third, health systems often aren't built for chronic care. We’ve gotten good at responding to emergencies—outbreaks, trauma, childbirth complications. But hypertension requires a long-term, steady approach: check-ups, coaching, affordable medication, and community support.

A Case for Hope

And yet, it’s not all doom. The good news? Hypertension is detectable, and treatable.

We have the tools. Thiazide diuretics and other effective medications cost just pennies a day. Lifestyle changes—like lowering salt intake, increasing physical activity, and managing stress—go a long way. And digital health is offering exciting new avenues: home blood pressure monitors, SMS reminders, telemedicine check-ins, and even AI-powered risk prediction.

Programs like WHO’s HEARTS initiative, and community-based interventions such as Resolve to save lives in countries like Ethiopia, India, Nigeria and so on show us what’s possible. Control rates improve when care is simplified, when patients are empowered, and when systems are held accountable.

From Silence to Action

The burden of hypertension is heavy, but it’s not inevitable. What we need now is momentum—public awareness, political will, and investment in frontline solutions. We need to normalize blood pressure checks the way we do COVID tests or pregnancy screens. We need to teach every household what a normal blood pressure looks like and how to manage it.

Because as Tom Frieden, CEO of Resolve to Save Lives, former CDC director and NYC health commissioner, would argue:

Treatment for high blood pressure is safe, simple and effective — it saves lives.

Treating high blood pressure is low-cost — for every dollar spent, 18 dollars can be saved.

Effective hypertension programs can be easily integrated into primary health care — and make it stronger.

So let’s break the silence. Let’s call hypertension what it is—a global emergency hiding in plain sight. And let’s act.