Raised blood pressure (BP) is responsible for 7.6 million deaths per annum worldwide (13.5% of the total), more than any other risk factors. Around 54% of stroke and 47% of coronary heart disease are attributable to high BP. Over 80% of this burden occurs in low and middle income countries (LMIC). BP and cardiovascular mortality are rising rapidly in LMIC. Although age-specific BP and cardiovascular mortality are falling in developed nations, the overall number of cardiovascular death continues to rise in accord with the rapid aging of societies. Because of the continuous relationship between BP and cardiovascular deaths down to 115/75 mmHg, BP-related disease also contributes to cardiovascular death among people below the hypertensive threshold of 140/90 mmHg. Hypertension remains "the silent killer". Reductions in the burden of BP-related death require the parallel application of the population strategy at community level and the clinical strategy focusing on new and improved treatments for people with hypertension.