Hypertension — master index¶
Last curated: 2026-09-01 · status: audited
The condition in five sentences. Hypertension is the world's largest modifiable cause of cardiovascular death, and its defining feature as a research object is that the science is settled far ahead of the delivery: the number of people aged 30–79 living with it doubled between 1990 and 2019 — from 331 million women (95% CrI 306–359) and 317 million men (292–344) to 626 million (584–668) and 652 million (604–698) — while age-standardised prevalence stayed flat, so the growth is demographic rather than a worsening of risk, and only 59% of women and 49% of men with hypertension had ever been diagnosed (NCD-RisC 2021, PMID 34450083). That treatment works is not in doubt: in 344,716 participants from 48 randomised trials, each 5 mm Hg fall in systolic pressure cut major cardiovascular events by about 10%, with no reliable heterogeneity by baseline pressure or prior disease (BPLTTC 2021, PMID 33933205). How far to lower has moved decisively toward a systolic target below 120–130 mm Hg — SPRINT (HR 0.73, 95% CI 0.63–0.86 for the primary composite; PMID 34010531), then ESPRIT and BPROAD overturning the long-standing diabetes exception (PMIDs 38945140, 39555827) — at a benefit–harm ratio where the number needed to treat (58) and the number needed to harm (55) are nearly equal (Guo 2025, PMID 40902616). The most under-appreciated finding in the field is how much hypertension is not primary: biochemically overt primary aldosteronism was present in 11.3% of normotensive people, 21.6% of stage 2 and 22.0% of resistant hypertension, and the aldosterone-renin ratio used to screen for it had poor sensitivity and negative predictive value (Brown 2020, PMID 32449886) — a finding that in 2025 moved the Endocrine Society to suggest screening everyone with hypertension (Adler 2025, PMID 40658480). What has actually moved population control is system redesign, not new molecules: village-doctor-led care raised control from 19.9% to 57.0% in 326 Chinese villages (Sun 2022, PMID 35500594), while US control peaked at 53.8% in 2013–2014 and fell to 43.7% by 2017–2018 (Muntner 2020, PMID 32902588).
Start here: overview.md. Research frontier: OPEN-QUESTIONS.md. Growth history: LOG.md.
The scoping decision that shapes this condition¶
hypertension returns 724,578 PubMed records — by a wide margin the largest literature in this repository. The failure mode here is not thinness but sprawl: hypertension touches almost every other condition already curated, and a page list drawn without borders would silently duplicate four of them.
This condition owns the exposure and its management. It does not own the end-organ diseases.
| Belongs here | Belongs elsewhere |
|---|---|
| Measurement, diagnosis, thresholds, phenotypes (white-coat, masked, nocturnal) | Cardiac end-organ disease — LVH, HFpEF, remodelling → hypertensive-heart-disease |
| Epidemiology and the detection–treatment–control cascade | Stroke, its acute care and secondary prevention → stroke |
| Pathophysiology, genetics, secondary causes | Coronary disease and its management → ischemic-heart-disease |
| Blood-pressure targets, drug and lifestyle therapy, resistant hypertension, devices | Blood-pressure lowering as dementia prevention → vascular-dementia, which already carries SPRINT MIND |
| Pregnancy, special populations, adherence and implementation, hypertensive emergencies | Diabetes management → type-2-diabetes |
The rule held through the build: cross-link, never restate. Where a trial matters to both conditions, each page cites it for its own endpoint and links the other rather than reproducing the analysis.
At a glance¶
| Layer | Built content |
|---|---|
| Canonical wiki pages | 20/20 written, all status: curated |
| Total wiki lines | 2,883 |
| Distinct live-resolved PMIDs across the audited wiki and literature corpus | 794 |
| Citations per page | 37–80 (median 51.5) |
| Landmark deep notes | 7 |
| Guideline registry entries | 40 documents, with supersession chains |
| Statistics rows | ~150 figures across 15 tables |
| ClinicalTrials.gov records in the audited wiki and literature corpus, live-verified | 61 |
| Open questions | 27 (12 Tier 1, 15 Tier 2) + 16 "dots not yet connected" |
| Total PubMed records for the condition | 724,578 |
Reading paths¶
If you have ten minutes. overview.md, then the "Dots not yet connected" table in OPEN-QUESTIONS.md.
If you want to know how low to treat. blood-pressure-targets.md → risk-and-outcomes.md for the J-curve → special-populations.md for the exceptions → guidelines.md for why bodies disagree.
If you distrust the number itself. definition-measurement-and-diagnosis.md → red-flags-and-safety-concerns.md § measurement error. This is the path most likely to change how you read every other page.
If you want the mechanism. pathophysiology.md → genetics-and-monogenic-forms.md → secondary-hypertension.md. The through-line is that every Mendelian form acts on renal salt handling.
If you treat patients whose pressure will not come down. resistant-and-refractory-hypertension.md → secondary-hypertension.md → device-and-interventional-therapy.md.
If you care about population control rather than individual care. epidemiology-and-burden.md → adherence-and-implementation.md → lifestyle-and-dietary-management.md § salt substitution → patient-experience-and-advocacy.md.
If you want the methodological lessons. device-and-interventional-therapy.md (sham control), pharmacological-therapy.md § chronotherapy (a corrected literature), hypertensive-emergencies.md (three observational studies and no trial).
Pages¶
The canonical page list for this condition (per CONVENTIONS.md §5). Every page was written from live literature searches during the build session of 2026-09-01.
| File | Scope | Lines | Cited PMIDs | Status |
|---|---|---|---|---|
| overview.md | What hypertension is, why the science-to-delivery gap defines it, map of the topic and its borders | 167 | 57 | curated |
| definition-measurement-and-diagnosis.md | Thresholds and why they differ between guidelines; office, home and ambulatory measurement; white-coat, masked and nocturnal phenotypes; measurement error as a first-order problem | 168 | 72 | curated |
| epidemiology-and-burden.md | Prevalence and its demographic drivers, the detection–treatment–control cascade, geographic and socioeconomic inequality, attributable burden | 141 | 42 | curated |
| pathophysiology.md | Renin-angiotensin-aldosterone system, sympathetic drive, renal sodium handling, arterial stiffness, endothelial function | 161 | 73 | curated |
| genetics-and-monogenic-forms.md | GWAS and polygenic scores, Liddle syndrome and other Mendelian forms, and what they revealed about sodium handling | 128 | 44 | curated |
| secondary-hypertension.md | Primary aldosteronism and its under-diagnosis, renovascular disease, phaeochromocytoma, sleep apnoea, drug-induced; who to screen and with what | 158 | 63 | curated |
| risk-and-outcomes.md | The exposure–outcome relationship across the pressure range, lifetime risk, the J-curve debate, and what is causal versus confounded | 120 | 39 | curated |
| blood-pressure-targets.md | SPRINT, ACCORD, STEP, ESPRIT, BPROAD and their disagreements; why guidelines set different numbers from the same trials; targets by population | 119 | 42 | curated |
| lifestyle-and-dietary-management.md | Sodium reduction and salt substitutes, DASH, potassium, weight, exercise, alcohol — with effect sizes and the durability problem | 141 | 52 | curated |
| pharmacological-therapy.md | Drug classes and comparative evidence, initial combination versus monotherapy, single-pill combinations, chronotherapy, adverse effects | 169 | 69 | curated |
| resistant-and-refractory-hypertension.md | Definitions and true prevalence after excluding pseudo-resistance, spironolactone evidence, newer agents | 129 | 47 | curated |
| device-and-interventional-therapy.md | Renal denervation across its sham-controlled trial history, baroreflex activation, and how the field recovered from an early negative result | 125 | 48 | curated |
| hypertension-in-pregnancy.md | Chronic hypertension in pregnancy, treatment thresholds, pre-eclampsia prevention, and long-term maternal cardiovascular risk | 128 | 52 | curated |
| special-populations.md | Chronic kidney disease, diabetes, older and frail people, ethnicity and the evidence on differential drug response | 151 | 80 | curated |
| adherence-and-implementation.md | Why control rates stay low, measurement of adherence, polypill, team-based care, task-shifting, and the trials that moved population control | 135 | 58 | curated |
| hypertensive-emergencies.md | Malignant hypertension, acute severe elevation, when and how fast to lower, and the harm of over-treatment | 111 | 37 | curated |
| guidelines.md | ACC/AHA, ESC/ESH, NICE, WHO and others: what each recommends, where they conflict, and why | 130 | 51 | curated |
| clinical-trials-landscape.md | Active and completed trials by intervention and phase, with enrolment, stage and posted safety data | 188 | 40 | curated |
| red-flags-and-safety-concerns.md | Missed secondary causes, over-treatment and hypotension, cuff and measurement error, unvalidated home devices, abrupt withdrawal | 164 | 57 | curated |
| patient-experience-and-advocacy.md | Living with an asymptomatic diagnosis, adherence from the patient's side, cost, organisations and research priorities | 150 | 39 | curated |
Literature layer¶
| Resource | Contents | Status |
|---|---|---|
| literature/BIBLIOGRAPHY.md | All 794 live-resolved records, grouped by domain and cross-indexed to every file that cites them; metadata regenerated from live esummary rather than transcribed | audited |
| literature/notes/ | 7 landmark deep notes: NCD-RisC 2021, BPLTTC 2021, SPRINT 2015, Brown 2020, SYMPLICITY HTN-3, SSaSS, CRHCP | audited |
| literature/guidelines/REGISTRY.md | 40 guideline documents worldwide with supersession chains, per-document notes, a numerically stated disagreements table, and a watch list | audited |
| literature/statistics/STATISTICS.md | 15 quick-reference tables — prevalence, cascade, attributable burden, dose–response, measurement, phenotypes, secondary causes, drug and target effect sizes, lifestyle, devices, implementation, harms, genetics, economics — with a 12-point conflicts-and-caveats section | audited |
| literature/patient-voice/ | Method and ethics, 18 verified organisations, 9 evidenced themes, annotated sources with coverage limits | audited |
Anchor records¶
The five records resolved while seeding this condition, all re-verified live at build time on 2026-09-01.
| PMID | Anchor | Re-verified |
|---|---|---|
| 34450083 | NCD Risk Factor Collaboration. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019. Lancet. 2021;398:957-980 | ✓ |
| 33933205 | Blood Pressure Lowering Treatment Trialists' Collaboration. Pharmacological blood pressure lowering... across different levels of blood pressure. Lancet. 2021;397:1625-1636 | ✓ |
| 26551272 | SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103-16 | ✓ |
| 32449886 | Brown JM, et al. The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study. Ann Intern Med. 2020;173:10-20 | ✓ |
| 39210715 | McEvoy JW, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45:3912-4018 | ✓ |
Status and next step¶
Every page is status: draft. Per CLAUDE.md, a model never audits its own writing: this build was written by claude and requires an independent audit by a different engine before any page is promoted to curated and before the condition is marked audited in CONDITIONS-ROADMAP.md. Items the auditor should prioritise are listed at the end of LOG.md.