Based on data from 64,136 individuals in the National Health Insurance Service–Health Screening Cohort in South Korea, 8,676 participants were newly diagnosed with hypertension during a mean follow-up period of 3.4 ± 1.9 years, resulting in a cumulative incidence of approximately 13.5%. [1] 

The age-standardized prevalence of hypertension among adults aged 20 years or older modestly decreased from 26.0% in 1998 to 21.8% in 2021. Over the same period, the age-standardized prevalence of hypertension among adults aged 30 years or older decreased from 30.7% to 26.8%. [2]

Out of 65,686 participants, 397 (0.6%) experienced hypertension-related avoidable hospitalizations within 1 year of their initial hypertension diagnosis. Individuals who experienced such hospitalizations had a significantly higher risk of all-cause mortality compared to those who did not (3-year: hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.53 to 2.94; 5-year: HR, 2.13; 95% CI, 1.68 to 2.68). [3] 

Before the age of 60, the prevalence of hypertension is higher in men than in women. However, in the age 60 s, the prevalence is similar between men and women, and after the age of 70, the prevalence of hypertension becomes higher in women.  In 2021, estimated people with hypertension were 4.3 million men and 2.6 million women under the age of 65, but 2.2 million men and 3.2 million women aged 65 years or older. [2] 

Among the participants, individuals aged 70 years and older accounted for the largest proportion, with 3,695 participants (20.0%), followed by 3,482 participants (18.8%) aged 60–69 years, and 3,445 participants (18.6%) aged 50–59 years. The number of participants in the 40–49, 30–39, and 20–29 age groups were 3,212 (17.4%), 2,481 (13.4%), and 2,196 (11.9%), respectively.  [2] 

Based on data from the National Health Insurance Services Senior Cohort (2008–2019), 41.7% of the study population resided in metropolitan areas, while 58.3% lived in non-metropolitan regions. [3] 

According to results of office office blood pressure (BP) and out-of-office measurements, individuals are categorized into four phenotypes: (1) normotension (office BP and out-of-office BP not elevated), (2) white coat hypertension (elevated office BP [≥140/90 mmHg] but not elevated out-of-office BP [≤135/85 mmHg in awake blood pressure and home blood pressure monitoring or ≤ 130/80 mmHg in 24-hour mean blood pressure by ambulatory blood pressure monitoring]), (3) masked hypertension (elevated out-of-office BP but not office BP), and (4) sustained hypertension (both elevated office BP and out-of-office BP). [4] 

Hypertension usually has no signs symptoms. Elevated resting heart rate [5], increased urine albumin-to-creatinine ratio within a normal range [6,7], and high platelet-to-lymphocyte ratio [8] were reported in patients with hypertension in Korea.

Among the 75,335 included participants, the progression rate to hypertension was 66.39% (50,013), Age, body mass index, hemoglobin, and family history of hypertension and other diseases were related to the progression. Among the progression group, 78.21% (39,116) participants skipped a pre-hypertensive status; this group consisted of older females with lower pulse pressure and more alcohol consumption compared to people who had pre-hypertensive status before the progression. [9] 

In general, the target systolic BP is <140 mmHg and diastolic BP is <90 mmHg, unless the patient has conditions such as diabetes mellitus or chronic kidney disease. It is reasonable to reduce BP below 130/80 mmHg in individuals with cardiovascular disease or high cardiovascular risk. On the other hand, it is recommended to control BP to less than 140/90 mmHg in low-risk and intermediate-risk groups. The main rationale of changing target BPs from around 130/80 mmHg to below 130/80 mmHg in high-risk patients is the adoption of corresponding BPs, which emphasize the balanced awareness of both white coat effect and masked effects during intensive BP control. [4] 

In 2021, the most frequently prescribed antihypertensive drug class was angiotensin receptor blockers (ARB) (75.1%), followed by calcium channel blockers (CCB) (61.7%), diuretics (23.4%), beta-blockers (15.3%), potassium-sparing diuretics (1.8%), and angiotensin-converting enzyme inhibitors (ACEi) (1.3%). The most commonly prescribed regimen for hypertension treatment was dual therapy involving ACEi/ARB plus CCB, followed by ARB monotherapy and CCB monotherapy. [2]   Among male patients, the usage frequency of ACEi/ARB was higher compared to female patients, while the usage frequency of diuretics was lower. [2] 

As the duration of hypertension increased, the risks of cardiovascular disease and stroke also increased. When hypertension lasts longer than 20 years, ischemic heart disease, myocardial infarction, and stroke prevalence were 14.6%, 5.0%, and 12.2%, respectively. However, achieving a target blood pressure goal below 140/90 mmHg reduced the risk of all cardiovascular disease and stroke by nearly half. Nevertheless, fewer than two-thirds of patients in Korea with hypertension achieved this targeted blood pressure goal. [10] 

In a longitudinal analysis (n=5,632), participants in the highest tertile of weighted genetic risk score had a 1.22-fold (OR=1.22, 95%CI, 1.02‒1.46) greater risk of incident hypertension relative to those in the lowest tertile, after adjusting for a number of confounding factors. [11] Among 153 single nucleotide polymorphisms (SNP)s in renin-related gene regions, two SNPs (rs11726091 and rs8137145) showed an association in the high-renin group, four SNPs (rs17038966, rs145286444, rs2118663, and rs12336898) in the low-renin group, and three SNPs (rs1938859, rs7968218, and rs117246401) in the total population. Most significantly, the low-renin SNP rs12336898 in the SPTAN1 gene, closely related to vascular wall remodeling, was associated with the development of hypertension (p-value = 1.3 × 10-6). [12] 

[1] Changes of Body Mass Index and the Incidence of Hypertension in Late Middle Age: A Nationwide Cohort Study in South Korea. Korean Journal of Health Promotion 22.4 pp. 175 - 182. (2022): 175. [2] Korean Society of Hypertension (KSH)–Hypertension Epidemiology Research Working Group. Korea Hypertension Fact Sheet 2023: analysis of nationwide population-based data with a particular focus on hypertension in special populations. Clin Hypertens. 2024 Mar 1;30(1):7.  [3] Impact of hypertension-related avoidable hospitalization on all-cause mortality in older patients with hypertension: a nationwide retrospective cohort study in Korea. Epidemiol Health. 2025;47.e2025019. [4] The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens. 2023 Feb;29(1):11. [5] The association of resting heart rate with diabetes, hypertension, and metabolic syndrome in the Korean adult population: The fifth Korea National Health and Nutrition Examination Survey. Clin Chim Acta. (2016) 455: 195-200 [6] Association between Urine Albumin-to-Creatinine Ratio within the Normal Range and Incident Hypertension in Men and Women. Yonsei Med J. (2016) 57: 1454-1460 [7] High-normal albuminuria predicts metabolic syndrome in middle-aged Korean men: a prospective cohort study. Maturitas (2014) 77: 149-154 [8] The platelet-to-lymphocyte ratio reflects the severity of obstructive sleep apnea syndrome and concurrent hypertension. Clin Hypertens. (2016) 22: 1 [9] Risk factors of the progression to hypertension and characteristics of natural history during progression: A national cohort study. PLoS One. 2020 Mar 17;15(3):e0230538. [10] Current Status of Cardiovascular Disease According to the Duration of Hypertension in Korean Adults. Glob Heart. 2023 May 10;18(1):25. [11] The Role of Genetic Risk Score in Predicting the Risk of Hypertension in the Korean population: Korean Genome and Epidemiology Study. PLoS One. 2015 Jun 25;10(6):e0131603. [12] Genome-Wide Association of New-Onset Hypertension According to Renin Concentration: The Korean Genome and Epidemiology Cohort Study. J Cardiovasc Dev Dis. 2022 Mar 30;9(4):104.