The Global Burden of Diseases Study 2010 (GBD 2010) reported that high blood pressure is the leading risk factor for global disease burden, and is estimated to cause 94 million deaths every yearmore than half of the estimated 17 million deaths a year caused by total cardiovascular disease. In 2012, the World Health Assembly set a global goal of a 25% reduction of premature deaths from non-communicable diseases (NCDs) by 2025 (the 25 by 25 goal). Among the set of voluntary targets is a 25% relative reduction in the prevalence of raised blood pressure. The new WHO report outlines crucial components for any country initiative to address hypertension, which include integrated primary care programmes, the provision of basic diagnosis and medicines, and the reduction of risk factors in the populationsuch as dietary salt consumption, smoking, and physical inactivity.To succeed in reducing hypertension worldwide, efforts should be targeted where they are most needed. The LancetSeries on NCDs reported that hypertension and other compounding risk factors for NCDs, such as tobacco and obesity, are increasingly concentrated in low-income and middle-income countries. 80% of deaths due to cardiovascular disease occur in countries and poor communities where health systems are weak. The African region has the highest prevalence of hypertension among adults older than 25 years. In China, more than 50% of the disease burden is expected to be from cardiovascular disease by 2050. Prompt management of high blood pressure can reduce the risk of complicationssuch as the development of atherosclerotic plaques, ischaemic heart disease, stroke, renal disease, and retinopathy. However, in the early stages, high blood pressure does not usually cause noticeable symptoms, and patients are left undiagnosed, or might not have access to treatment. Treatment of the complications of hypertension, such as cardiac bypass surgery and renal dialysis, are expensive, and can rapidly deplete family and national budgets. Cardiovascular disease, including hypertension, now accounts for nearly half of the estimated US$500 billion annual lost economic output associated with NCDs in low-income and middle-income countries.Strong leadership and a multi-sectorial approach are crucial to successfully address these challenges. One promising new leadership entity was welcomed earlier this week into the NCD fray. Public Health England (PHE), a new executive agency of the UK Department of Health, is described in a World Report this week. Duncan Selbie, the new Chief Executive, is also profiled in this issue. One of PHE's key priorities is to reduce preventable deaths from disorders such as heart disease, stroke, cancer, and diabetes. Although there is hope that the new system will more effectively address the social determinants of health by combining multi-sectorial functions in one agency, it remains to be seen how successful PHE will be in supporting and inspiring local government.Modification of behavioural risk factors and medical treatment of people at high risk for cardiovascular disease continue to be the best way forwardboth to reduce the burden of high blood pressure, and to make progress towards the 25 by 25 goal. But WHD 2013 must be more than a fleeting moment for hypertension. In the context of the dismal progress on