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This chapter discusses the definition and classification of hypertension, its prevalence, treatment and control, as well as risk factors for and risks of the condition. According to JNC 7, normal blood pressure (BP) is defined as systolic blood pressure (SBP) <120 mm Hg and diastolic blood pressure (DBP) <80 mm Hg. Individuals with SBP of 120-139 mm Hg or DBP of 80-89 mm Hg are classified as having prehypertension. Individuals with SBP of 140-159 mm Hg or DBP of 90-99 mm Hg are classified as having stage 1 hypertension whereas those with SBP ≥160 mm Hg or DBP ≥100 mm Hg are considered to have stage 2 hypertension. In the USA, ~33% of adults aged ≥20 years have hypertension; prevalence is highest among non-Hispanic blacks, and increases with age and body-mass index. In the period 2007-2012, ~77% of hypertensive individuals were being treated and ~54% had their hypertension under control. In addition to age, race/ethnicity, and body-mass index, other major risk factors for hypertension include tobacco use and diet (see accompanying Hurst's Central Illustration). Among individuals aged <60 years, men are more likely to have the condition; the inverse is true among older adults. Hypertension significantly increases the risk of stroke and cardiovascular disease, and is the top attributable cause of death worldwide.

eFig 23-01

Hurst's Central Illustration: Risk Factors for Hypertension and Risks of the Condition

Various risk factors are associated with the development of hypertension, which in turn increases the risk of the development of cerebrovascular and cardiovascular disease.


Elevated blood pressure (BP) is the top attributable cause of mortality globally, responsible for some 7.5 million deaths annually (approximately 12.8% of all deaths) and accounts for 57 million disability-adjusted life years.1 Global prevalence of elevated BP in 2008 was approximately 40%, being highest (46%) in the World Health Organization African region and lowest in the Americas, around 35% overall for both men and women. Approximately one billion persons throughout the world have uncontrolled hypertension, an increase from 600 million in 1980.

Hypertension is the most prevalent chronic condition in the United States and the most common reason for an office visit to a physician. It accounts for the most drug prescriptions and is one of the most important risk factors for heart disease and stroke.2 This chapter reviews the epidemiology of hypertension—how it is defined and classified, the extent of its prevalence, treatment, and control, and its relation to cardiovascular and other consequences.


Hypertension can be quantified on the basis of a large number of epidemiologic studies showing that the distribution of BP in the population is continuous, although the curve is skewed at the higher levels of BP. The unimodal distribution of BP implies that hypertension is unlikely to be the result ...

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