Why is hypertension so hard to get under control?

Imagine a middle-aged office worker going through a typical working day.

He feels healthy. He has no obvious symptoms and no reason to think anything is wrong. Then, during a routine health examination, he is told that his blood pressure is high.

What happens next is where things become more complicated.

He needs to confirm the diagnosis, start effective treatment and return for follow-up. If his blood pressure remains high, treatment may need to be adjusted. And even when it comes down, he needs to stay in treatment and care.

It sounds straightforward. But achieving and sustaining blood pressure control is far from simple.

Hypertension often has no symptoms, so many people do not know they have it. Even after high blood pressure is detected, people may fall out of care along the way—for example, because diagnosis or treatment is delayed, treatment is not adjusted when needed, follow-up is interrupted, medicines are difficult to access, or care competes with the demands of work and everyday life.

This is not a challenge faced by just a few – it is a global one.  Around 1.4 billion adults aged 30–79 worldwide are living with hypertension—roughly one in three. Yet only 23% have their blood pressure under control.

We know what works. The challenge is making it work.

The WHO HEARTS technical package translates decades of evidence into a practical approach for primary health care, including accurate blood pressure measurement, standardized evidence-based treatment, access to essential medicines, team-based care and systems for monitoring patients and improving quality. More than 40 countries are now implementing large-scale HEARTS programmes, with over 45 million patients enrolled in care.

In September 2026, the WHO China Office and the National Center for Cardiovascular Diseases jointly organized the International Forum on Standardized Hypertension Care and Quality Improvement in Beijing. Chinese policymakers and experts joined international hypertension leaders to examine global evidence, implementation experience and practical priorities for improving hypertension control.

At the Forum, Prof. George Stergiou, President of the International Society of Hypertension, highlighted three practical ingredients for translating evidence into routine care: simple guidance that frontline providers can act on, team-based care that makes better use of non-physician health workers, and digital tools that support consistent treatment and follow-up.

Every step in the patient journey matters

Finding people is the first challenge. Because hypertension is usually asymptomatic, people who feel healthy may have little reason to seek care – particularly working-age people who have limited contact with primary health care.

Diagnosis is only the beginning. People need effective treatment, timely adjustment when blood pressure remains high, reliable access to medicines and regular follow-up. Health workers need practical tools to make consistent treatment decisions, while health systems need to know who is controlled, who is not and who is being lost from care.

At the Forum, Prof. Gianfranco Parati, President of the World Hypertension League, emphasized the importance of sustaining control across the entire patient journey. “The central challenge is not whether treatment works. It is whether effective care continues—month after month, year after year.”

He also emphasized the need to close the loop between measurement and action: blood pressure information should reach the care team, trigger treatment adjustment when needed and generate feedback to the patient. Digital tools can help, but only when embedded in a care pathway with clear responsibilities.

The world has committed to act

In 2025, world leaders agreed on a global target for 150 million more people to have their hypertension under control by 2030. China, home to one of the world's largest populations of people living with hypertension, has an important role to play.

China has a strong foundation to build on

Hypertension prevention and management are already integrated into China's primary health care system, including through the National Basic Public Health Services Programme, family doctor services and health examinations. Across the country, local governments and health facilities have also accumulated considerable experience in early detection, community-based management and long-term care.

The question for China is therefore increasingly not simply what works, but how to make what works reach more people, consistently and at scale.

Discussions at the Forum pointed to several areas for further action in China: stronger team-based care, with non-physician health workers playing a greater role in supporting primary care providers; simple, standardized treatment protocols for primary care; and better-connected information systems to support follow-up, treatment adjustment and quality improvement. Participants also highlighted health-system incentives oriented towards better outcomes and public education to improve awareness and support long-term treatment.

The Forum also marked an important milestone: the establishment of China's National Hypertension Expert Committee. Bringing together expertise across clinical medicine, public health and health systems, the Committee provides a national technical platform to help translate evidence and implementation experience into practical approaches for improving hypertension control.

“We already have strong scientific evidence on how to tackle hypertension, and China has a strong foundation to build on,” said Martin Taylor, WHO Representative to China. “The next step is to turn what we already know into more people getting their blood pressure under control. That means finding people with hypertension earlier, providing high-quality treatment, and supporting people to stay in treatment and care for the long term.”

^{Establishment of China’s National Hypertension Expert Committee   Credit: National Center for Cardiovascular Diseases}

From priorities to action

WHO will continue to work with the Government of China, the National Hypertension Expert Committee and experts across relevant fields to adapt global evidence and practical experience to the Chinese context, support approaches suited to China’s health system, and generate practical evidence to inform wider implementation.

China has one of the world's largest health systems, a strong primary health care foundation and rapidly developing digital health capabilities. As it works to further improve hypertension control at home, China also has an opportunity to contribute valuable lessons to other countries facing similar challenges. For the office worker who first discovers high blood pressure at a routine health examination, all of this ultimately comes down to something much simpler:

Was his hypertension found early? Did he receive effective treatment? Was he supported to stay in care? And years later, is his blood pressure still under control?

Every controlled blood pressure is an opportunity to prevent a stroke or heart attack – and to protect a life.

The goal is to make blood pressure control the expectation, not the exception.

^{Citizens checking blood pressure at primary health care center in China   Credit: WHO China}