Background: Primary hypertension is one of the leading non-communicable diseases worldwide and remains the foremost modifiable risk factor for cardiovascular morbidity and premature mortality. Nearly 90–95% of hypertension cases are classified as primary (essential) hypertension, in which no single identifiable cause is established. The prevalence of hypertension rises substantially during middle adulthood (40–60 years), owing to age-related vascular changes, unhealthy lifestyle practices, obesity, metabolic disturbances, psychosocial stress, and genetic predisposition. Although contemporary medicine has significantly reduced cardiovascular risk through lifestyle modification and pharmacotherapy, individualised complementary approaches such as homoeopathy continue to be explored as supportive strategies for holistic patient care.

Objective: To critically review current evidence regarding the epidemiology, risk factors, pathophysiology, clinical aspects, and conventional management of primary hypertension in middle-aged adults while exploring the scope of homoeopathic therapeutics and comparative Materia Medica from an evidence-informed integrative perspective.

Methods: A narrative integrative literature review was conducted using peer-reviewed articles, international hypertension guidelines, systematic reviews, meta-analyses, textbooks, and evidence from biomedical and homoeopathic literature published predominantly between 2014 and 2025. Databases consulted included PubMed, Scopus, Web of Science, Google Scholar, and guideline repositories. Information was synthesized narratively under predefined thematic headings.

Results: Primary hypertension results from multifactorial interactions among genetic susceptibility, neurohormonal dysregulation, endothelial dysfunction, vascular remodeling, chronic inflammation, oxidative stress, and environmental influences. Middle adulthood represents a critical stage during which cumulative cardiovascular risk factors substantially increase disease prevalence. Lifestyle interventions remain the cornerstone of prevention, while pharmacological therapy effectively reduces cardiovascular events. Homoeopathic management emphasizes individualized constitutional prescribing based on symptom totality, although current evidence supporting efficacy remains limited and heterogeneous, highlighting the need for rigorous clinical investigations.

Conclusion: An integrative understanding of primary hypertension requires consideration of biomedical mechanisms alongside individualised patient-centred approaches. While conventional management remains the evidence-based standard of care, homoeopathy may offer supportive holistic management in appropriately selected patients. Future interdisciplinary research should emphasize high-quality randomized controlled trials and standardized reporting to strengthen the evidence base.